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At least 217 records · Page 12Linked to original sources
PubMed2002

Thoracoscopic sympathectomy: endobronchial anesthesia vs endotracheal anesthesia with intrathoracic CO2 insufflation.

PURPOSE: To compare clinical advantages and hemodynamic and respiratory changes during one lung-collapsed ventilation (OLCV) using a double-lumen tube (DLT) or a single-lumen tube (SLT) with intrathoracic CO(2) insufflation, in patients undergoing thoracic sympathectomy (TS) under general anesthesia. METHODS: One hundred and twenty-five patients (94 men and 31 women) undergoing TS for the treatment of palmar hyperhidrosis (PH) were randomly allocated to two groups: group A (68 patients; age, 29 +/- 6 years) in whom DLT was used, and group B (57 patients; age, 32 +/- 3 years) in whom SLT with intrathoracic CO(2) insufflation at a rate of 0.5-1 l.min(-1) and sustained intrathoracic pressure at 6 mmHg insufflation were used. Anesthesia was maintained with 1 minimum alveolar concentration (MAC) isoflurane in 50% nitrous oxide in oxygen with incremental doses of sufentanil and atracurium when required. Arterial blood gases were measured in 10 patients in group B. Hemodynamic and respiratory parameters were obtained perioperatively. RESULTS: There were no significant differences in hemodynamic and respiratory parameters between the two groups during the study phases, except for the arterial oxygen saturation (SpO(2)). The times required for anesthesia and surgery were significantly shorter in the SLT group than in the DLT group. SpO(2) during OLCV was 95 +/- 1% with DLT and 98 +/- 1% with SLT, with a significant difference. Three patients had an SpO(2) of less than 90% in the recovery room, where the chest tube position was readjusted, with no further sequelae. CONCLUSION: General anesthesia with SLT and intrathoracic CO(2) insufflation provides optimal operating conditions, adequate oxygenation, and perfect hemodynamic stability during TS.

Clinical Trial↗
PubMed1995

Hemodynamic effects of prolonged abdominal insufflation for laparoscopic procedures.

Abdominal insufflation for laparoscopic procedures leads to numerous hemodynamic effects. We focused on blood flow distribution and arterial and venous pressure changes during CO2 insufflation at an intra-abdominal pressure of 12 mm Hg. Three segments of the vascular system were investigated (intrathoracic, cranial extrathoracic, caudal extrathoracic) in supine animals at insufflation, during a 90-minute period of pneumoperitoneum, and at desufflation. Except for instrumentation of the animals, no further surgery was performed. At insufflation (+5 minutes), cardiac output increased from 2.7 +/- 0.5 to 3.3 +/- 1.1 L/min while heart rate decreased from 138 +/- 26 to 128 +/- 17 beats per minute. Increases in jugular venous (from 6 +/- 1 to 11 +/- 4 mm Hg) and atrial (right, from 7 +/- 1 to 12 +/- 3; left, from 12 +/- 4 to 17 +/- 5 mm Hg) pressures occurred uniformly during inspiration. The great variance in atrial pressures during ventilation was not associated with changes in stroke volume, as the effective transmural filling pressures remained nearly constant. The increase in femoral venous pressure occurring during both inspiration and expiration (from 10 +/- 2 to 18 +/- 4 mm Hg) exceeded the increase in right atrial and jugular venous pressures during inspiration. Parallel increases were noted in arterial pressures (carotid, from 119 +/- 15 to 129 +/- 9; femoral, from 122 +/- 16 to 133 +/- 10 mm Hg), left ventricular pressure (from 133 +/- 17 to 143 +/- 10 mm Hg), and carotid and femoral flow (carotid, from 174 +/- 71 to 195 +/- 70; femoral, from 66 +/- 25 to 73 +/- 40 (NS) mL/min).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1999

Air embolus associated with tubal insufflation.

A patient underwent laparoscopy for a rectovaginal mass, dysmenorrhea, and infertility. After CO(2) pneumoperitoneum was established the laparoscope was placed without difficulty. Before the procedure was completed, the tubes were insufflated with air through a 20-ml syringe attached to a Cohen cannula. Tubes were patent. No other intraabdominal manipulation was performed at that time. During tubal insufflation the patient's end-tidal CO(2) decreased to 18%, partial pressure of oxygen decreased to 83%, and pulse increased to 130/minute. The CO(2) pneumoperitoneum was released, and the woman stabilized spontaneously. The CO(2) pneumoperitoneum was again established, with no further difficulty. The time relationship with tubal insufflation and lack of recurrence on reestablishing pneumoperitoneum suggest that air embolization during tubal insufflation occurred.

Adult↗
PubMed1984

Esophageal insufflation testing in nonlaryngectomized adults.

Esophageal insufflation testing has been advocated for laryngectomized patients considered for tracheoesophageal puncture. The present work was undertaken to document the degree to which nonlaryngectomized individuals were able to produce and sustain esophageal voice in association with esophageal insufflation testing. Fifteen young, healthy adults were tested in a uniform way. Results were interpreted to support the views that (a) normal function of the pharyngoesophageal segment represents an influence detrimental to the ultimate acquisition of functionally serviceable esophageal or tracheoesophageal speech and (b) laryngectomized patients having airtight closure of the pharyngoesophageal segment during insufflation testing exhibit a normal esophageal response. Implications for completing air insufflation testing and selective myotomy are discussed.

Adult↗
PubMed2001

Tracheal gas insufflation apparatus. Performance of a novel phase-specific device.

Tracheal gas insufflation is a technique in which gas is injected intratracheally during positive pressure ventilation. The fresh gas rinses expired gas from the tracheal tube and anatomical dead space, aiding carbon dioxide elimination. This reduces ventilatory volume and pressure, helping to reduce ventilator-induced lung damage. Complications of tracheal gas insufflation include interference with ventilator function, tracheal damage and barotrauma. Expiratory washout is a variation of tracheal gas insufflation. We designed and constructed an original expiratory washout system and evaluated its safety and performance in lung and animal models. We found that expiratory limb and tracheal tube occlusion tests caused the device to disable itself at acceptable intratracheal pressures. We also demonstrated up to 31% reduction in tidal volume compared with conventional ventilation, supporting the possibility of using this device clinically to lessen volutrauma. We concluded that aspects of this design might alleviate many of the safety concerns of using tracheal gas insufflation.

Animals↗
PubMed1991

Respiratory, laryngeal, and tracheal responses to nasal insufflation of volatile anesthetics in anesthetized humans.

In order to determine whether or not irritation of the nasal passage with commonly used volatile anesthetics can elicit airway reflexes, we investigated respiratory, laryngeal, and tracheal responses to nasal insufflation of three volatile anesthetics (enflurane, isoflurane, and halothane) in 13 patients anesthetized with flunitrazepam, pentazocine, and nitrous oxide. The trachea of each patient was intubated with a saline-filled double-cuffed endotracheal tube. Changes in breathing pattern were measured with a pneumotachograph while changes in laryngeal wall tension and tracheal wall tension were assessed by measuring changes in the proximal cuff pressure and the distal cuff pressure, respectively. In 8 of 13 patients, the dose-response relationship for each anesthetic was determined by administering different concentrations (1, 3, and 5%) of gas mixtures. In these patients, nasal insufflation of 1 and 3% of each anesthetic did not produce any reflex response, whereas reflex responses were evident during nasal insufflation of 5% enflurane, isoflurane, and halothane. In all 13 patients, nasal insufflation of all three anesthetics at a concentration of 5% invariably produced changes in breathing pattern characterized by prolongation of expiratory time (TE). However, prolongation of TE was the most pronounced for enflurane (from a control value of 2.1 +/- 0.5 to a maximum value of 4.8 +/- 2.2 s [mean +/- standard deviation]), less for isoflurane (from 2.2 +/- 0.5 to 3.9 +/- 1.7 s), and the least for halothane (from 2.2 +/- 0.6 to 2.9 +/- 0.9 s).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

The safety of laparoscopy performed by direct trocar insertion and carbon dioxide insufflation under vision.

The records of 6,173 laparoscopies performed by specialist gynaecologists in the course of routine gynaecological care using the technique of direct insertion of the umbilical trocar and insufflation of carbon dioxide under vision were reviewed to ascertain the incidence of serious complications. A review of the published literature on laparoscopy methodology was also undertaken to complement the data obtained from this study. The nature of the records precluded accurate assessment of both indications and minor complications. There were 4 perforating bowel injuries (0.06%) requiring laparotomy (s small intestine, 2 large intestine). There were no cases of major vascular injury or gas embolus necessitating surgical or resuscitative measures. On 3 of the 4 occasions where bowel injury occurred the patients had undergone prior abdominal surgery and had midline vertical subumbilical incisions. Review of the published literature demonstrated bowel or vessel perforation rates (requiring laparotomy or resuscitation) of 1 in 1,000 regardless of whether the method of gaining peritoneal access was open (Hasson) technique, Verres needle insufflation, or direct trocar. Direct trocar insertion may reduce the risk of gas embolism by insufflating only after intraperitoneal replacement has been confirmed, moreover it allows immediate recognition and rapid treatment of major blood vessel laceration, both of which have been identified as being crucial in reducing laparoscopy associated mortality. When compared to other available methods of gaining peritoneal access for laparoscopy, direct trocar insertion followed by insufflation of carbon dioxide under vision can be performed with the same degree of safety for the patient. It is simply wrong to deduce from the available data that one particular technique of gaining peritoneal access is superior to another. Each have their individual advantages and disadvantages and similar morbidity when performed by experienced operators with appropriate indications. In light of this observation, each alternative should be considered by the individual surgeon to assess which would best suit his or her operating technique and the particular circumstance of each patient. Indeed preference should be given to the method with which the surgeon is most comfortable or with which he or she has the most experience.

Carbon Dioxide↗
PubMed1988

Constant oxygen insufflation (COI) in a ventilatory failure model.

We examined the use of a constant insufflation of oxygen into the lungs to assist ventilation in a ventilatory failure model. The model consisted of 12 anesthetized dogs (17 to 32 kg) that were partially paralyzed using intermittent low doses of muscle relaxant; this produced a steady-state mean PaCO2 of 90 +/- 15.8 mm Hg (+/- SD). A catheter (1.5 mm ID) was inserted into each lung to the most distal position possible and withdrawn 1 to 2 cm. The effects of a constant insufflation of oxygen at rates of 5, 10, or 20 L/min were studied at this position (mean distance from the carina = 9 +/- 2 cm); at the carina; and using a single catheter located 2 cm above the carina. The changes in PaCO2 and minute ventilation (VE) due to the insufflation were calculated from the mean steady-state control values. Using the data for all catheter positions and flow rates, the insufflation was associated with a mean decrease in PaCO2 of 31 (+/- 7.6) mm Hg associated with a mean decrease in VE of 48 (+/- 12.9)%. The flow of 20 L/min caused a significantly greater drop in PaCO2 than the flow of 5 L/min (p = 0.02). This technique may prove beneficial for patients with various forms of ventilatory failure that are difficult to treat by conventional means.

Acute Disease↗
PubMed2000

Maximum insufflation capacity.

OBJECTIVE: To investigate the effect of deep lung insufflations on maximum insufflation capacities (MICs) and peak cough flows (PCFs) for patients with neuromuscular disease. METHOD: Forty-three patients with neuromuscular disease were trained in stacking delivered volumes of air to deep lung insufflation and were prescribed a program of air stacking once their vital capacities (VCs) were noted to be < 2,000 mL. VC, MIC, and unassisted and assisted PCF were monitored. The initial data were compared with the highest MICs subsequently achieved. For those patients whose MICs only decreased, we compared the initial data with the most recent data. RESULTS: The MICs increased from (mean +/- SD) 1,402 +/- 530 mL to 1,711 +/- 599 mL (p < 0.001) for 30 patients and only decreased for 13 patients. Patients for whom the MICs increased also had a significant increase in assisted PCF from 3.7 +/- 1.4 to 4.3 +/- 1.6 L/s (p < 0.05) despite having somewhat decreasing VCs and unassisted PCFs. CONCLUSION: With training, the capacity to stack air to deep insufflations can improve despite progressive neuromuscular disease. This can result in increased cough effectiveness.

Adult↗
PubMed2004

Cardiovascular effects of insufflation of the abdomen with carbon dioxide in standing horses sedated with detomidine.

OBJECTIVE: To determine the cardiovascular effects of 60 minutes of abdominal insufflation with CO2 to an intra-abdominal pressure of 15 mm Hg in standing horses receiving a constant rate infusion of detomidine. ANIMALS: 5 horses. PROCEDURE: Horses were randomly allocated into treatment or control groups. A washout period of a minimum of 7 days separated the 2 experimental periods of the crossover study. Catheters were placed into the right atrium, pulmonary artery, jugular vein, and right transverse facial artery after lidocaine infiltration. All horses were sedated with detomidine (8.54 microg/kg/h, i.v.). Horses in the treatment group received abdominal insufflation with CO2 via a laparoscopic cannula to a final and constant intra-abdominal pressure of 15 mm Hg for 60 minutes. Systemic arterial pressure, right atrial pressure, heart rate, cardiac output, core body temperature, and the pH and gas tensions of arterial and mixed venous blood were obtained. Cardiac index and systemic vascular resistance were calculated. Data were collected in 3 stages: preinsufflation (-10 and -5 minutes), insufflation (0, 15, 30, 45, and 60 minutes), and postinsufflation (70 and 80 minutes). The quality of sedation and level of analgesia were determined. RESULTS: The PaO2 of horses in the treatment group was significantly higher after 60 minutes of pneumoperitoneum than in the control group. Core body temperature decreased significantly from baseline in both groups. CONCLUSIONS AND CLINICAL RELEVANCE: A 60-minute period of abdominal insufflation to an intra-abdominal pressure of 15 mm Hg did not induce significant cardiovascular abnormalities in healthy horses.

Analysis of Variance↗
PubMed2000

Comparison of insufflation vs. retractional technique for laparoscopic-assisted intervertebral fusion of the lumbar spine.

Laparoscopic transperitoneal fusion of the L5-S1 spinal interspace has become a common procedure. Retroperitoneal retraction and laparoscopic instrumentation without insufflation also allows visualization of the upper lumbar spaces, but this procedure is much more difficult to accomplish. We review and compare our results using each of these techniques for the treatment of mechanical instability and chronic back pain. A total of 35 selected patients underwent intervertebral fusion between February 1996 and August 1998. Their mean age was 48 years. There were 22 female and 13 male patients. Standard CO2 insufflation was used in 10 patients with L5-S1 fusions. Retractional gasless technique was used in nine patients with fusions at L5-S1, 16 patients at L4-L5, one patient at L3-L4, three patients at L2-3, and one patient at L1-L2. Thus, we performed a total of 40 lumbar fusions in 35 patients. In the 19 patients with the gasless technique, a balloon dissector and retractor facilitated the retroperitoneal exposure. Seven of these 19 patients were converted to open procedures, most commonly due to lacerations of the peritoneal lining that prohibited visualization. None of the L5-S1 patients with insufflation were converted to open. Mean operative time in the insufflated patients was 152 min vs. 181 min for the retractional technique. There were seven complications in the transperitoneal group: one fusion device migration, one postoperative UTI, one intracerebral hemorrhage, one severe postoperative pancreatitis, and three iliac vein lacerations. There were 16 complications in the retroperitoneal group: one deep vein thromboses, one serosal bowel injury, one small tear in the spleen, one cage migration, one postoperative pulmonary atelectasis, one postoperative hydrocele, four postoperative ileus, and six peritoneal tears. The mean postoperative stay was three days for both groups. There were no deaths. The L5-S1 interspace is best approached transperitoneally for anterior fusion. Although the retroperitoneal retractional technique is much more difficult and has a longer and steeper learning curve, it does allow laparoscopic anterior fusion of the upper lumbar spine.

Female↗
PubMed2000

[Continuous flow ventilatory support using a multijet insufflation catheter. Physical, mathematical and clinical prerequisites and principles].

The authors present theoretical principles of a new ventilatory support continuous flow ventilatory support (CFVS) with multijet insufflation catheter (MIC). Theoretical part of the presented work reasons the need of this type of ventilatory support and explains basic mathematical and physiologic principles of described mechanical ventilation method and reveals the advantages of continuous flow ventilatory support with multijet insufflation catheter in comparison with terminal eye catheter. Physical and mathematical analysis on a model of lungs in static and dynamic conditions revealed that the difference in the value of maximal inspiratory pressure is significantly higher in the system with terminal eye catheter and confirmed that the CFVS application with multijet insufflation catheter is connected with minimal risk of barotrauma by gas flow up to 20-26 l/min. The paper concludes that continuous flow ventilatory support with multijet insufflation catheter is more efficient with the possibility of significantly higher gas flow application than with terminal eye catheter and without the risk of pressure rise in the airways and without rise of breathing work. (Fig. 10, Ref. 11.)

Humans↗
PubMed2000

[Continuous flow ventilatory support with multijet insufflation catheter. Initial clinical experience].

BACKGROUND: Clinical application of continuous flow ventilatory support with multijet insufflation catheter is not mentioned in the literature until now. Despite the use of various forms of ventilatory support, in 10-30% of patients disweaning from mechanical ventilation is unsuccessful even if they fulfil clinical and biochemical criteria. AIM: To evaluate the efficiency of a new ventilatory support continuous flow ventilatory support with multijet insufflation catheter--in clinical conditions. METHODS: Continuous flow ventilatory support with original, patented multijet insufflation catheter with nasal installation into the trachea was used in a group of 14 patients. In a subgroup of 8 patients with chronic obstructive lung disease (COLD) was this method used for development of global respiratory insufficiency due to infectious complications and in a subgroup of 6 patients it was successfully used as a ventilatory model for weaning of patients from longterm mechanical ventilation in whom other ventilatory modes for weaning were unsuccessful. RESULTS: No patient with COLD had to be intubated and 30 minutes after the start of ventilatory support with multijet insufflation catheter mean respiratory frequency decreased from 33 +/- 2.8 to 27 +/- 2.5 d/min, paCO2 from 11.9 +/- 1.7 to 10.8 +/- 1.6 kPa and paO2 increased from 5.7 to 6.8 +/- 1.3 kPa by FiO2 of 0.3. Up to 24 h after the start of ventilatory support blood gases were improved to values characteristic for partial respiratory insufficiency. Frequency of spontaneous ventilation decreased to 20 +/- 2.2, paCO2 decreased to 6.4 +/- 1.2 kPa and paO2 continually increased reaching the value of 8.9 +/- 1.4 (FiO2 = 0.3) in the 24th hour of ventilatory support. Ventilatory support lasted in average 5 days, than it could be removed. In the second group of patients continuous flow ventilatory support was used because of unsuccessful weaning following longterm mechanical ventilation. After extubation and 30 minutes after continuous flow ventilatory support start the breathing frequency decreased to 27 +/- 2.5 d/min, paCO2 showed further fall to the value of 3.9 +/- 0.9 due to hyperventilation caused evidently by continuing paO2 decrease to the value of 8.8 +/- 1.4 kPa. Only after 60 minutes following the start of ventilatory support, by equal breathing frequency, the values of blood gases increased (paO2 to 9.9 +/- 1.5 kPa, paCO2 to 5.2 +/- 1.1 kPa) and also Vt increased (0.38 +/- 0.3) which allowed to carry on with continuous flow ventilatory support, it could be interrupted after 48 hours. CONCLUSION: On the basis of the obtained results it can be stated that continuous flow ventilatory support represents an efficient ventilatory mode in patients with chronic obstructive lung disease with global respiratory insufficiency and enables to bridge the period of management e.g. of infectious complications without intubation and mechanical ventilation. As a noninvasive ventilatory regime it can be also used of patients from longterm mechanical ventilation. Application in acute respiratory for weaning (ARF, ARDS) requires further prospective studies. (Tab. 5, Fig. 4, Ref. 28.)

Aged↗
PubMedDate not supplied

Laparoscopic surgery with carbon dioxide insufflation causes respiratory acidosis.

This study analyzes the changes in cardiopulmonary parameters of patients undergoing laparoscopic cholecystectomy. Six healthy females with normal preoperative cardiopulmonary status were selected for laparoscopic surgery using the same criteria as for traditional cholecystectomy. Respiratory and cardiovascular parameters were collected and compared prior to peritoneal insufflation and just before desufflation. Patients experienced significant elevations of arterial and end-tidal CO2, accompanied by decreased pH. Bicarbonate concentration, blood pressure and pulse rate remained constant. Based on these results, and on our laboratory investigations, we have introduced helium as an alternate agent for insufflation, and present the data from the first two patients so managed. No change was observed in EtCO2, PaCO2 or pH in either of these two patients during the course of surgery. We conclude that hypercarbia occurs in those undergoing laparoscopic cholecystectomy with CO2 insufflation. This acidosis requires compensation by increased minute ventilation to prevent decline in pH. In our initial experience, helium did not produce these changes, and therefore merits further investigation as an alternate agent for abdominal insufflation.

Acidosis, Respiratory↗
PubMed1991

Techniques of emergency ventilation: a model to evaluate tidal volume, airway pressure, and gastric insufflation.

We designed a model to evaluate the effectiveness of various noninvasive methods of ventilation. The upper airway was simulated with the head of a Resusci-Annie which was attached to a test lung. The esophagus and stomach were simulated with a Penrose drain connected to a rolling seal spirometer via a PEEP valve. Fifteen paramedic volunteers ventilated the model utilizing mouth-to-mouth, mouth-to-mask, bag-valve-mask, or portable field ventilator (Impact or HARV). Recording of tidal volume, gastric volume, and proximal and distal airway pressure was completed at three different levels of compliance. At normal compliance, all methods except the HARV met or exceeded American Heart Association standards. As compliance decreased, tidal volume fell and gastric insufflation increased. At a compliance of 0.02 L/cm H2O all methods failed to meet AHA standards and gastric insufflation volume equalled delivered tidal volumes for mouth-to-mouth and mouth-to-mask techniques. Mouth-to-mouth and mouth-to-mask techniques generated the largest tidal volumes but also created the largest volume of gastric insufflation. The Impact ventilator provided an acceptable tidal volume with minimal gastric insufflation. Our results suggest that mouth-to-mask ventilation with supplemental oxygen enrichment is the most efficient technique for non-invasive airway management.

Airway Resistance↗
PubMed1990

[Preservation of the isolated canine heart for 24 hours by retrograde gaseous oxygen insufflation].

Isolated canine hearts were used to evaluate retrograde gaseous oxygen insufflation into the heart at 4 degrees C compared with simple storage as a method of preservation for 24 hours. The hearts were reperfused with ex vivo apparatus and assessed by left ventricular functional recovery and myocardial energy metabolism. Gas insufflated hearts showed significantly better maintenance of creatine phosphate and adenosine triphosphate content, lower lactate accumulation, and better functional recovery compared with simple storage. However, at the early period of reperfusion, coronary vascular resistance rose significantly in gas-insufflated hearts. Gas-insufflation storage of isolated hearts is capable of maintaining aerobic metabolism, and may be suitable for long distant heart procurement. However, this method may cause gas embolism or any vascular damage which impair the beneficial effects.

Animals↗
PubMed1989

[Comparative studies of the quality of the esophageal voice following laryngectomy: the insufflation test and reverse speech audiometry].

We carried out a transnasal insufflation test according to Blom and Singer on 27 laryngectomy patients as well as a speech communications test with the help of reverse speech audiometry, i.e. the post laryngectomy telephone test according to Zenner and Pfrang. The combined evaluation of both tests provided basic information on the quality of the esophagus voice and functionability of the speech organs. Both tests can be carried out quickly and easily and allow a differentiated statement to be made on the application possibilities of a esophagus voice, electronic speech aids and voice prothesis. Three groups could be identified from our results: 1. Insufflation test and reverse speech test provided conformable good or very good results. The esophagus voice was well understood. 2. Complete failure in the insufflation and telephone tests calls for further examinations to exclude any spasm, stricture, divertical and scarred membrane stenosis as well as tumor relapse in the region of the pharyngo-esophageal segments. 3. Organic causes must be looked for in the area of the nozzle as well as cranial nerve failure and social-determined causes in the case of normal insufflation and considerably reduced speech communication in the telephone test.

Adult↗
PubMed1982

[Treatment of intestinal invagination with particular emphasis on reduction by colonic insufflation. Report on 5110 cases].

The author reports 5110 cases of intussusception in infancy and childhood treated during the last 21 years. He makes a complete analysis on age, sex and seasonal frequency of 1597 cases met in the first six year period (1960 to 1965). Then, a statistic of 4 chief symptoms of 1000 consecutive cases under two years of age is given: abdominal pain 95,2%, vomiting 91,7%, bloody stool 83,3%, and sausage-shaped mass 73,6%. Among 5110 cases, only 512 were laparotomized, there were demonstrable organic causes in 22 cases. The method of reduction by colonic insufflation is described in detail step by step, with its indications, counterindications and possible complications. The author also presents his air insufflation apparatus with automatic control of the intracolonic pressure. Finally, he emphasizes the advantages of this method: of 4841 cases submitted to colonic insufflation, complete reduction was achieved in 4598, i.e. 94.98%, the rate of reduction is higher than that of barium enema. Thus, this method greatly decreased the need of operation, and consequently reduce the mortality and morbidity of the disease. Reduction of intussusception by colonic insufflations performed ambulatory and at a very low cost.

Air↗