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Diffusion of anaesthetic gases through different polymers.

BACKGROUND: Improvement of working conditions and anaesthesia with closed systems includes reduction of gas leaks during anaesthesia. One source of contamination is the permeation of gases through plastic materials. The volume of gas permeating through a polymer depends on its molecular structure, the solubility and the diffusion coefficient. METHODS: We designed an experimental set-up to measure the permeation rates of nitrous oxide, enflurane and isoflurane through components of the anaesthetic ventilator made of silicone, latex, rubber and polyvinylchloride (PVC). Reservoir bags, ventilation tubes and endotracheal tubes were investigated. RESULTS: The highest permeation rates of anaesthetic gases were observed with silicone materials. Permeation through silicone exceeded that of the least permeable material by more than 10.000 times. By summarizing the permeation rates of the single items, the use of silicone increases the anaesthetic system's leakage rate by 4 ml/min, which means an increase of 18% in a modern anaesthetic ventilator and of 31% in a closed system. CONCLUSIONS: The highest permeation rates were found for nitrous oxide through silicone, although nitrous oxide has a known low solubility in plastic materials. The result demonstrates the dependency of the leakage rate on the diffusibility. The leakage of anaesthetic gases caused by silicone items does not alone lead to unacceptable pollution of operating theatres. To minimize the total leakage rates of minimal-flow-systems, however, plastic materials with low solubility and low diffusion coefficients have to be used.

Anesthesia, Inhalation↗

Lack of relation between fetal blood gases and fetal blood flow velocity waveform indices found in rhesus isoimmunised pregnancies.

OBJECTIVE: To investigate the relation between umbilical vein blood gas components and the vascular resistance in four fetal arteries in Rh-immunised pregnancies. DESIGN: A prospective observational study over a 4-month period. SETTING: King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. SUBJECTS: Fifteen Rh-isoimmunised pregnant women. INTERVENTIONS: Pulsed Doppler examinations of the umbilical artery, fetal internal carotid artery, thoracic aorta and abdominal aorta before transabdominal fetal blood sampling from the umbilical vein on 38 occasions. MAIN OUTCOME MEASURES: Doppler flow velocity pulsatility index (PI), systolic/diastolic ratio (A/B) and resistance index (RI) in the four fetal arteries investigated were related to the umbilical vein blood gases and acid-base status (PO2, PCO2, O2-content, CO2-content, HCO3, base excess and lactate concentration). RESULTS: There were no correlations between the Doppler indices in any of the vessels studied and the blood gases components in the umbilical vein. The ratios between the corresponding Doppler indices in the different vessels were also independent of the blood gases and acid-base status and there were no significant differences in the Doppler indices in the same vessel between fetuses with blood gas values over the 75th centile and those with values below the 25th centile. CONCLUSION: This study does not support a reduction in peripheral vascular resistance in the fetal cerebrum in relation to fetal hypoxia in Rh-immunized pregnancies.

Blood Flow Velocity↗

The influence of blood gases on alpha 1- and alpha 2- adrenoceptor-mediated pressor responses in the pithed rat.

The influence of blood gases on alpha 1- and alpha 2-adrenoceptor-mediated pressor responses was studied in the pithed rat by varying the inspired gas mixture or the ventilation stroke volume. Acidosis favoured the peak responses to the alpha 2-adrenoceptor agonist, xylazine, while alkalosis favoured the peak responses to the alpha 1-adrenoceptor agonist, phenylephrine. A combination of hypoxia and hypercapnia greatly depressed the alpha 1 response to phenylephrine whereas the alpha 2 response to xylazine remained relatively unaffected. When Pao2 was varied in either acidotic or alkalotic conditions the response to the phenylephrine increased as Pao2 increased. To prevent hypoxia in air ventilated rats, large stroke volumes were required. This caused alkalosis and hence decreased responsiveness to xylazine. Consequently, air ventilated pithed rats gave poorer responses to xylazine than did those ventilated on 100% O2. The results show that alpha 1- and alpha 2-adrenoceptor-mediated pressor responses can be differentially affected by blood gases. The relative contribution of alpha 1- and alpha 2-adrenoceptors to vascular tone may be either under- or over-estimated depending on the arterial blood gases.

Animals↗

Differences in Myocardial Contrast Produced with Transient Response Imaging When Using Intravenous Microbubbles Containing Gases of Different Molecular Weight.

The purpose of this study was to determine the effect of different microbubble gases on the amount of myocardial contrast (MC) produced from intravenously (IV) injected dextrose albuinin microbubbles when using a new imaging modality termed transient response imaging (TRI). In 6 dogs (4 closed chest, 2 open chest) the peak anterior myocardial videointensity (PMVI) and visual degree of MC were determined following IV injections of equivalent doses of perfluorocarbon exposed sonicated dextrose albumin (PESDA), sulfur hexafluoride-exposed sonicated dextrose albumin (SHESDA), and room air exposed sonicated dextrose albumin (RASDA) microbubbles. TRI was performed by triggering ultrasound impulses to 1 point every one to two cardiac cycles. The PMVI produced with TRI was compared to conventional 30 Hz frame rate imaging (CI) for each gas. Visual anterior and posterior MC was evident with TRI in all six dogs using PESDA, but not in any dog with CI. Although RASDA and SHESDA did not produce MC with CI, visually evident anterior MC was seen after 7 of 8 SHESDA and 4 of 9 RASDA injections when using TRI with both gases. PESDA produced the highest peak PMVI of all three microbubbles when using TRI, while SHESDA produced a significantly higher PMVI than RASDA. We conclude that although MC can be produced with TRI using microbubble gases of lower molecular weight, the brightest and most consistent contrast is produced with fluorocarbon containing microbubbles.

Journal Article↗

Anevac-D, a new system for close scavenging of anesthetic gases in dental practice.

Anevac-D, a new system for close scavenging of anesthetic gases in dental practice is described. It consists of a rubber nose mask surrounded by an outer rigid shell and a chin scavenger. A vacuum in the slot between the nose masks provides scavenging of gases escaping from the inner mask. Gases escaping from the mouth are evacuated mainly by the skin scavenger. The efficiency of this system was assessed in healthy volunteers using argon as a tracer gas. Mass spectrometry was used for measurement of inspired, expired, and scavenged gas concentrations. The scavenging efficiency of the complete system was around 80% and was not affected by poor patient cooperation. It decreased to about 65% when the chin scavenger was removed. The dentist's exposure was measured by sampling of argon in the breathing zone by a Saran system. The average 4-min exposure varied between 90 and 250 ppm depending on system configuration and patient cooperation. Patient acceptance and clinical applicability were judged good. It is concluded that the Anevac-D system provides excellent scavenging properties and exposure levels well within the official recommendations by the Swedish Board of Occupational Safety and Health.

Adolescent↗

Tunable quasi-two-dimensional electron gases in oxide heterostructures.

We report on a large electric-field response of quasi-two-dimensional electron gases generated at interfaces in epitaxial heterostructures grown from insulating oxides. These device structures are characterized by doping layers that are spatially separated from high-mobility quasi-two-dimensional electron gases and therefore present an oxide analog to semiconducting high-electron mobility transistors. By applying a gate voltage, the conductivity of the electron gases can be modulated through a quantum phase transition from an insulating to a metallic state.

Journal Article↗

An anaerobic chemostat that permits the collection and measurement of fermentation gases.

A chemostat was designed to allow anaerobic growth in the culture vessel in the absence of a continuous stream of O(2)-free gas. Produced gases were collected within the culture and collection vessels, and pressure build-up was prevented by allowing gases to expand into a collapsed football bladder. The culture overflow was collected in a flask, held at 0 C, that was emptied by applying a positive CO(2) pressure to the system. Ruminococcus albus, a H(2) and CO(2)-producing anaerobe, was used to test the operation of the apparatus. H(2) production was measured by sampling the various gas spaces of known volume and measuring H(2) concentration by gas chromatography. Measurement of accumulated fermentation gases and the effects of the accumulation on fermentations can be studied with the apparatus.

Anaerobiosis↗

A control system for arterial blood gases.

A system was developed to control arterial O2 and CO2 partial pressure (Pao2, and Paco2) simultaneously and independently of each other. The system makes changes in inspired fractional concentration of O2 and CO2 based on values for end-tidal O2 and CO2 partial pressure. The system was applied in 23 normal subjects. In attempts to maintain a Pao2 of 90 Torr and a Paco2 of 40 Torr, arterial blood gases were 91.1 +/- 6.5 (SD) Torr for Pao2 and 41.2 +/- 3.2 Torr for Paco2. In attempts to maintain a Pao2 of 40 Torr and a Paco2 of 40 Torr, arterial blood gases were 40.4 +/- 3.9 Torr for Pao2 and 38.9 +/- 2.5 Torr for Paco2. In attempts to maintain a Pao2 of 90 Torr and a Paco2 of 55 Torr, arterial blood gases were 98.1 +/- 11.5 Torr for Pao2 and 52.8 +/- 3.4 Torr for Paco2. Coefficients of variations ranged from 7.1 to 11.7% for Pao2 and 6.4 to 7.8% for Paco2.

Adolescent↗

Mechanisms of gas exchange with different gases during constant-flow ventilation.

To investigate the mechanisms responsible for the difference in gas exchange during constant-flow ventilation (CFV) when using gases with different physical properties, we used mixtures of 70% N2-30% O2 (N2-O2) and 70% He-30% O2 (He-O2) as the insufflating gases in 12 dogs. All dogs but one had higher arterial PCO2 (PaCO2) with He-O2 compared with N2-O2. At a flow of 0.37 +/- 0.12 l/s, the mean PaCO2's with N2-O2 and He-O2 were 41.3 +/- 13.9 and 53.7 +/- 20.3 Torr, respectively (P less than 0.01); at a flow rate of 0.84 +/- 0.17 l/s, the mean PaCO2's were 29.1 +/- 11.3 and 35.3 +/- 13.6 Torr, respectively (P less than 0.01). The chest was then opened to alter the apposition between heart and the lungs, thereby reducing the extent of cardiogenic oscillations by 58.4 +/- 18.4%. This intervention did not significantly alter the difference in PaCO2 between N2-O2 and He-O2 from that observed in the intact animals, although the individual PaCO2 values for each gas mixture did increase. When the PaCO2 was plotted against stagnation pressure (rho V2), the difference in PaCO2 between N2-O2 and He-O2 was nearly abolished in both the closed- and open-chest animals. These findings suggest that the different PaCO2's obtained by insufflating gases with different physical properties at a fixed flow rate, catheter position, and lung volume result mainly from a difference in the properties of the jet.

Animals↗

Respiratory failure: correlation between encephalopathy, blood gases and blood ammonia.

In 59 patients with respiratory insufficiency due to chronic obstructive pulmonary disease (COPD) the relationship between the state of consciousness, the blood gases and blood ammonia were studied. Interindividually, a significant correlation was found between the encephalopathy and SaO2, PaCO2 or ammonia, and also between the blood gases and ammonia. On the other hand, an intraindividual study, performed on patients with minor cerebral dysfunction, showed that only PaCO2 was significantly correlated with the stage of consciousness. Ammonia did not appear to have a neurotoxic influence. The ammonia level seemed to be influenced primarily by other factors than the blood gases, although there was a borderline influence of SaO2 on aterial ammonia and a significant influence of PaCO2-HCO3 and pH on venous ammonia.

Adult↗

The relationship between arterial blood gases and serum theophylline clearance in critically ill patients.

Theophylline clearances were monitored at 8-h intervals in a group of critically ill patients and changes in the clearances were correlated with changes in the arterial blood gases. A total of 183 samples from 20 patients were analyzed. The initial theophylline clearance ranged from 20 to 89 ml/kg/h. The initial clearances could not be predicted from the patient's age, arterial blood gases, or the presence of congestive heart failure, liver dysfunction, or other medical problems. For individual patients, the theophylline clearance varied markedly during the study, with the mean maximal clearance averaging 54% higher than the mean minimal clearance. Changes in clearances were not correlated with changes in the arterial blood gases. On the basis of this study, we recommend an initial aminophylline infusion rate of 0.5 mg/kg/h in all critically ill patients. Serum theophylline concentrations should then be determined at 24-h intervals until stabilization and at 48-h intervals thereafter with appropriate adjustments in aminophylline doses.

Aged↗

A method for the long-term exposure of rabbits to environmental pollutant gases.

The aims of the present study were twofold. Firstly, we wanted to develop a system for the exposure of rabbits to pollutant gases that would monitor gas concentrations accurately, allow flexibility, be simple to operate, and could be constructed at relatively modest cost. Additionally, we wanted to determine whether the procedures necessary for the daily exposure of young rabbits had any detrimental effect on their development. Using the environmental exposure system that we developed, littermate New Zealand White rabbits, neonatally immunized to either Alternaria tenuis or house dust mite antigen were exposed 2 h daily, from within 24 h of birth until 3 months of age, to either 4 ppm nitrogen dioxide (NO2), or 5 ppm sulphur dioxide (SO2) or ambient air. The environmental exposure system consists of four sections; a stainless steel exposure chamber; an airflow monitoring and control system and gas delivery system; a gas detector and monitoring system; and an exhaust fan. Equilibration and wash-out times of gas were short and the gas mixing within the chamber atmosphere was uniform. Levels of gases were reliably maintained throughout the period of exposure within predetermined limits. The weights of the immunized, gas-exposed animals did not differ significantly from those of the immunized, air-exposed animals at any time throughout the 3 month period of exposure. At 3 months of age, the basal values for lung resistance and dynamic compliance did not differ between gas- and air-exposed rabbits. These values did not differ significantly from those obtained from naive animals of the same age. Our results suggest that we have developed a sensitive, reliable and simple environmental exposure and monitoring system. It is anticipated that the methodology described will allow the careful investigation of the effects of long-term exposure to pollutant gases from birth on the development of airways hyperresponsiveness.

Air Pollutants↗

A strategy for determining arterial blood gases on the summit of Mt. Everest.

BACKGROUND: Climbers on the summit of Mt. Everest are exposed to extreme hypoxia, and the physiological implications are of great interest. Inferences have been made from alveolar gas samples collected on the summit, but arterial blood samples would give critical information. We propose a plan to insert an arterial catheter at an altitude of 8000 m, take blood samples above this using an automatic sampler, store the samples in glass syringes in an ice-water slurry, and analyze them lower on the mountain 4 to 6 hours later. RESULTS: A preliminary design of the automatic sampler was successfully tested at the White Mountain Research Station (altitude 3800 m-4300 m). To determine how much the blood gases changed over a long period, rabbit blood was tonometered to give a gas composition close to that expected on the summit (PO2 4.0 kPa (30 mmHg), PCO2 1.3 kPa (10 mmHg), pH 7.7) and the blood gases were measured every 2 hours for 8 hours both at sea level and 3800 m. The mean changes were PO2 +0.3 to +0.4 kPa (+2 to +3 mmHg), PCO2 0 to +0.13 kPa (+1 mmHg), pH -0.02 to +0.04, base excess -0.7 to +1.2 mM. In practice the delay before analysis should not exceed 4 to 6 hours. The small paradoxical rise in PO2 is presumably caused mainly by contamination of the blood with air. CONCLUSION: We conclude that automatic arterial blood sampling at high altitude is technically feasible and that the changes in the blood gases over a period of several hours are acceptably small.

Altitude↗

[Auto-PEEP effects on respiratory mechanics and blood gases in mechanically ventilated patients]

OBJECTIVE: The purpose of this study was to examine the auto-PEEP incidence and magnitude and the relationship between its reductions and changes in respiratory mechanics and gas exchanges in mechanically ventilated patients addmited in an Intensive Care Unit.METHODS: A prospective study was conducted in seventeen infants undergoing mechanical ventilation due to respiratory or neuromuscular diseases. We have measured blood gases, mean airway pressure, tidal volume, compliance, resistance and time constants of the respiratory system and monitored pressure, flow and volume waveforms and pressure-volume and flow-volume loops.RESULTS: Thirteen patients or 76% developed auto-PEEP and the reduction of its magnitude (from 5.4 -/+ 3.2 to 4.1 -/+ 2.6 cmH2O, p<0.01) showed association to mean airway pressure decrease (from 10.2 -/+ 3.1 to 9.3 -/+ 2.3 cmH2O, p<0.01), tidal volume (from 45.3 -/+ 19.1 to 51.3 -/+ 22.9 ml, p<0.01) and corrected compliance increase (1.02 -/+ 1.20 to 1.13 -/+ 1.41 ml/cmH2O/kg, p=0.05). Expiratory resistance remained unchanged (from 15.0 -/+ 8.6 to 15.7 -/+ 9.4 cmH2O/l/sec/kg, p=0.06). Arterial blood gases showed pH increase (from 7.37 -/+ 0.12 to 7.42 -/+ 0.05, p<0.05) and PCO2 and PO2 decrease (from 40.1 -/+ 11.1 mmHg to 33.1 -/+ 7.4 mmHg, p<0.01 and 65.0 -/+ 13.9 to 58.0 -/+ 12.6 mmHg, p<0.01 respectively).CONCLUSIONS: Auto-PEEP reduction was associated with pulmonary mechanics and blood gases improvement. Knowledge of auto-PEEP presence and magnitude allowed to respiratory system compliance and time constants correction, providing accurate index of the pulmonary mechanics.

Journal Article↗

Sonography-guided fetal blood sampling for pH and blood gases in premature fetuses with abnormal fetal heart rate traces.

In nine pregnancies, remote from term, with an abnormal Non-Stress Test (NST) and Bio-Physical Profile (BPP) of 3 or above, cordocentesis for fetal blood gas analysis was performed. In seven cases an immediate post-partum blood sample was taken from the fetal cord for a similar analysis. The two tests gave very similar results. The results showed fetal acidemia (pH 7.09-7.19 and B.E. -10-15) in 4 cases, followed by immediate delivery. In the remaining 5 cases, normal blood gases were evident (pH 7.28-7.35); despite the abnormal NST, pregnancy was allowed to continue for 2 to 7 weeks, under close supervision. At birth, 2 out of 9 newborns were deemed by the neonatologist suffering from asphyxia. Both belonged to the acidemic group of women who were managed by immediate cesarean section. The other 5 fetuses, which were managed expectantly, had normal post-partum blood gases or Apgar score; none had asphyxia. Fetal blood gas analysis, on samples obtained by cordocentesis, provides useful information that can assist in the management of premature fetuses suspected of being distressed, according to their heart traces. Normal fetal blood gases can identify those fetuses falsely identified by the NST as in distress and thereby spare them unnecessary premature birth with its known complications.

Acidosis↗

Occupational exposure to trace concentrations of waste anesthetic gases.

The relationship between exposure to trace concentrations of waste anesthetic gases in the operating room and the possible development of adverse health effects has concerned health care professionals for numerous years. Results of studies have been conflicting. In the late 1960s and early 1970s, some US and European epidemiological studies of operating room personnel showed an increase in the incidence of adverse health effects, including spontaneous abortion and development of congenital abnormalities in offspring. However, subsequent analysis of these studies by 2 independent groups showed that the apparent increase in adverse health effects was most likely due to flaws in these studies' methods and data collection. A later prospective study showed no causal relationship between exposure to trace concentrations of waste anesthetic gases and adverse health effects. Each institution should have a waste anesthetic gas management program that includes scavenging of waste anesthetic gases, work practices to reduce contamination, documented maintenance and regular checking of all equipment, and education of all personnel on this subject. A mechanism for reporting work-related health problems should be in place in each institution.

Abnormalities, Multiple↗

Exposure to anesthetic gases and ethanol during work in operating rooms.

The concentration of halothane and ethanol in operating rooms was measured during 37 routine operations performed in nine different departments of surgery at six different hospitals. The time-weighted halothane concentrations in the respiratory zones of anesthetic and surgical nurses were 0.3--34.0 ppm (time-weighted average 7.2 ppm) and 0.1--9.2 ppm (time-weighted average 2.5 ppm), respectively, in the different operating departments. The corresponding ethanol concentrations were 0.3--36.5 ppm (time-weighted average 12.5 ppm) for anesthetic nurses and 1.5--46.6 ppm (time-weighted average 15.3 ppm) for surgical nurses. The anesthetic technique influences the exposure of the operating staff to anesthetic gases, but it does not affect exposure to ethanol. In controlled experiments volunteers were exposed to low concentrations of halothane or ethanol. About 60% of both substances was retained. The content of ethanol in the end-expired air approached zero within a few minutes after the end of exposure, while low residual concentrations of halothane were demonstrable for more than 1 h. Although exposure to ethanol is insignificant in relation to the metabolic capacity of the body, ethanol indicates the presence of volatile disinfectant components, and its spread through the room atmosphere should be kept in mind when the ventilation of operating rooms is designed. The effective elimination of airborne pollutants in operating rooms calls for good general ventilation in conjunction with local exhaust close to the sources of anesthetic gas leakage. General ventilation mainly affects the concentration of substances well-mixed with the room atmosphere, such as volatile disinfectant components and anesthetic vapor that has spread beyond the actual work zones of the medical staff. For a significant reduction in the concentration of anesthetic gases in the respiratory zones of the medical staff, the gases must be vented at the source of leakage. Since airborne anesthetics occur not only in operating rooms, general ventilation has to meet certain minimum requirements also in anesthetic induction rooms and recovery rooms. Operating rooms and anesthetic induction rooms must also be supplied with local exhaust systems.

Air Conditioning↗

Factors affecting the concentration of combustible gases in the colon during colonoscopy.

The colonic concentrations of the combustible gases, H2 and CH4, were well below hazardous levels in 60 consecutive patients at the time of colonoscopy. Independent analysis of the effect of a low residue liquid diet, a 12-hr fast, and bowel cleansing on the pulmonary excretion of these gases suggest that the low colonic concentrations encountered were largely the result of our patient preparation procedure. Both ingestion of the liquid diet and fasting decreased the pulmonary excretion of H2 markedly but caused only a slight fall in CH4 excretion. Thus H2, but not CH4, production appears to depend on the delivery to the colonic bacteria of exogenous fermentable substrate. Bulk removal of bacteria from the colon resulted in about a 10-fold reduction in the excretion of both gases. The results of these studies do not support the need for routine CO2 insufflation prior to colonoscopic electrosurgical polypectomy.

Cathartics↗