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PubMed1980

Pneumoperitoneum following vaginal insufflation and coitus.

A 25-year-old woman developed bilateral lower abdominal and pleuritic chest pain radiating to the shoulders 30 min after oral-genital insufflation and conventional coitus. Radiographic evaluation demonstrated a pneumoperitoneum. This was attributed to a traumatic 5-mm rent in the vaginal cuff occurring six months after post-vaginal hysterectomy. Mild symptomatology and the absence of peritoneal irritation should suggest a vaginal etiology for pneumoperitoneum, and allow consideration of conservative management. Post-coital pneumoperitoneum after abdominal hysterectomy has been reported; however, we believe this to be the first such reported case after vaginal hysterectomy and associated with oral-genital insufflation.

Adult↗
PubMed2002

The effect of various insufflation gases on tumor implantation in an animal model.

OBJECTIVE: The expanded use of laparoscopy has led to reports of tumor dissemination and spread to laparoscopic port sites. We previously showed that carbon dioxide insufflation produced tumor dissemination compared with laparotomy. It is unknown whether the type of gas used influences this dissemination. Although carbon dioxide is commonly used during laparoscopy, helium and nitrous oxide could be used. This study was undertaken to compare the effects of carbon dioxide, helium, and nitrous oxide gas on tumor spread in an animal model to determine whether the type of gas used for the pneumoperitoneum would affect tumor spread. STUDY DESIGN: Viable MATB mammary adenocarcinoma cells were injected into the peritoneal cavity of Fisher 344 rats (1 x 10(5) cells/rat). The animals were then divided into three groups. Four 18-gauge angiocaths were inserted into each of four quadrants of the peritoneal cavity, and induction of pneumoperitoneum with helium, nitrous oxide, or carbon dioxide gas was done at approximately 7 mm Hg for 2 hours. Animals were killed at 7 days and the ventral peritoneal wall and abdominal cavity were examined for evidence of tumor formation. Tumor implants were counted for each of the four quadrants on the anterior peritoneal wall and for the total abdominal cavity. RESULTS: A total of 39 rats were studied with 13 animals per group. The total number of implants was calculated for the groups: carbon dioxide, n = 57; helium, n = 62; nitrous oxide, n = 66. There was no significant difference in the total number of implants according to the type of gas or the size of implants. When implants that were <5 mm were analyzed, the four quadrants of the anterior peritoneum showed a random difference in tumor disbursement between one quadrant in the helium (n = 15) and one quadrant in the nitrous group (n = 23). However, when the three gasses were compared with all four quadrants, there was no statistical significance (carbon dioxide, n = 35; helium, n = 38; nitrous oxide, n = 44). CONCLUSION: There is no difference in tumor implantation when with use of carbon dioxide, helium, or nitrous oxide gas in an animal model. Thus, carbon dioxide insufflation does not appear to increase tumor spread compared with other gasses.

Adenocarcinoma↗
PubMed1994

An unusual case of maternal-fetal death due to vaginal insufflation of cocaine.

Air embolism secondary to vaginal insufflation has been documented as a cause of death in pregnant women. Under pressure, the air enters the uterus, causing air emboli within the uterine venous drainage and subsequently the systemic circulation. Death is usually sudden as the air obstructs the normal flow of circulation. Acute cocaine toxicity is also a well-known cause of sudden death. Cocaine use is prevalent in our society, even among pregnant women. We report the sudden death of a 31-year-old gravid female and 39-week gestational age male fetus. The cause of death was air embolism secondary to oral-vaginal insufflation of cocaine smoke.

Administration, Intravaginal↗
PubMed2000

Efficacy of continuous insufflation of oxygen combined with active cardiac compression-decompression during out-of-hospital cardiorespiratory arrest.

BACKGROUND: During experimental cardiac arrest, continuous insufflation of air or oxygen (CIO) through microcannulas inserted into the inner wall of a modified intubation tube and generating a permanent positive intrathoracic pressure, combined with external cardiac massage, has previously been shown to be as effective as intermittent positive pressure ventilation (IPPV). METHODS: After basic cardiorespiratory resuscitation, the adult patients who experienced nontraumatic, out-of-hospital cardiac arrest with asystole, were randomized to two groups: an IPPV group tracheally intubated with a standard tube and ventilated with standard IPPV and a CIO group for whom a modified tube was inserted, and in which CIO at a flow rate of 15 l/min replaced IPPV (the tube was left open to atmosphere). Both groups underwent active cardiac compression-decompression with a device. Resuscitation was continued for a maximum of 30 min. Blood gas analysis was performed as soon as stable spontaneous cardiac activity was restored, and a second blood gas analysis was performed at admission to the hospital. RESULTS: The two groups of patients (47 in the IPPV and 48 in the CIO group) were comparable. The percentages of patients who underwent successful resuscitation (stable cardiac activity; 21.3 in the IPPV group and 27.1% in the CIO group) and the time necessary for successful resuscitation (11.8 +/- 1.8 and 12.8 +/- 1.9 min) were also comparable. The blood gas analysis performed after resuscitation (8 patients in the IPPV and 10 in the CIO group) did not show significant differences. The arterial blood gases performed after admission to the hospital and ventilation using a transport ventilator (seven patients in the IPPV group and six in the CIO group) showed that the partial pressure of arterial carbon dioxide (PaCO2) was significantly lower in the CIO group (35.7 +/- 2.1 compared with 72.7 +/- 7.4 mmHg), whereas the pH and the partial pressure of arterial oxygen (PaO2) were significantly higher (all P < 0.05). CONCLUSIONS: Continuous insufflation of air or oxygen alone through a multichannel open tube was as effective as IPPV during out-of-hospital cardiac arrest. A significantly greater elimination of carbon dioxide and a better level of oxygenation in the group previously treated with CIO probably reflected better lung mechanics.

Adolescent↗
PubMedDate not supplied

Maximum insufflation capacity: vital capacity and cough flows in neuromuscular disease.

OBJECTIVE: To investigate the relationships between vital capacity (VC), maximum insufflation capacity (MIC), and both unassisted and assisted peak cough flows (PCFs). DESIGN: The 108 patients were divided into two groups, those whose MICs were greater than their VCs (group 1) and those whose MICs could not exceed their VCs (MIC = VC, or group 2). RESULTS: The MIC correlated positively with the VC for group 1 patients, but the percent increase in MIC correlated negatively with VC. Both VC and MIC correlated significantly with both unassisted and assisted PCF, respectively. Assisting the cough increased the PCF of 37 patients over a previously defined critical level of 2.7 L/sec. The MIC VC difference and percent increase in MIC also correlated significantly with the difference between unassisted and assisted PCF. Although the group 2 patients did not have true cough flows because of inability to close the glottis, their peak expiratory flows were significantly less than the unassisted and assisted PCF of the group 1 patients. CONCLUSIONS: The greater the MIC VC difference, the greater the PCF, and, thereby, the ability to expel airway mucus and avert respiratory complications. The lower the VC, the greater the percent increase in MIC and the greater the percent increase in assisted PCF. Maximal insufflations are extremely important to increase PCF for patients with neuromuscular conditions who have VCs of < 1500 ml.

Adult↗
PubMed1987

Prevention of suction-induced hypoxemia by simultaneous oxygen insufflation.

The effects of endotracheal suctioning were studied in 38 patients. A significant decline in arterial oxygen tension and saturation was noted in all patients. A new double lumen suction catheter that simultaneously insufflates oxygen while suctioning was tested in these same patients and was found to prevent hypoxemia in all patients. We recommend that the insufflation catheter be added to the protocol of hyperventilation with 100% oxygen to help prevent suction-induced hypoxemia.

Cardiac Surgical Procedures↗
PubMed1997

Continuous low-flow tracheal gas insufflation during partial liquid ventilation in rabbits.

BACKGROUND: Both partial liquid ventilation (PLV) and tracheal gas insufflation are novel techniques for mechanical ventilation. In this study we examined whether PLV superimposed by continuous low-flow tracheal gas insufflation (TGI) offers any advantage to the blood gases and lung mechanics in normal-lung rabbits compared to the use of PLV only. METHODS: Eighteen anesthetized, paralyzed and mechanically ventilated rabbits were used. After obtaining a baseline PaCO2 value between 29 and 39 mmHg (3.9 and 5.2 kPa), the animals were assigned to three equal groups according to the ventilation they received--A group: PLV superimposed by TGI; B group: PLV only; and C group: continuous mandatory ventilation (CMV) superimposed by TGI. Serial arterial blood gases, pH and lung mechanics were measured. RESULTS: The animals in each group were hemodynamically stable. In the case of the A group, PaO2 continuously increased, and PaCO2 stabilized around 40.8 +/- 5.5 mmHg (5.4 +/- 0.7 kPa, mean +/- SD, NS). In the B group, the tendency for PaO2 to increase was not as definite; PaCO2 continuously increased from 35.2 +/- 2.3 mmHg (4.7 +/- 0.3 kPa) to 56.3 +/- 12.7 mmHg (7.5 +/- 1.7 kPa, P < 0.05) at the end of the experiment. In the C group, PaO2 and PaCO2 were stable during the observation period. The superimposition of TGI on PLV did not decrease the airway pressures compared to PLV alone. CONCLUSION: In summary, continuous low-flow TGI superimposed on PLV can decrease and stabilize the PaCO2 elevation caused by the initiation of PLV.

Animals↗
PubMed1984

The recovery of gases insufflated at laparoscopy.

The recovery of gases used for insufflation at gynaecological laparoscopy was investigated in 163 women who were randomly allocated to receive insufflation with nitrous oxide or carbon dioxide, the two most commonly used gases. No difference was detected and since nitrous oxide has dangerous side effects, the use of carbon dioxide is recommended. Methods of enhancing the recovery of gas were then investigated in a further 207 women, treatment being allocated in a random fashion. No merit was found in the use of these techniques and they have been abandoned.

Carbon Dioxide↗
PubMed1992

Alveolar oxygenation and mouth-to-mask ventilation: effects of oxygen insufflation.

The effect on alveolar oxygen fraction (FAO2) of insufflating oxygen under a mask (or through an inflow nipple provided in the mask) during simulated mouth-to-mask ventilation was investigated using a lung model. A variety of commercially produced masks were evaluated. Two patterns of artificial ventilation were applied: 1. 500 ml tidal volume at 20 breaths per minute, and 2. 900 ml tidal volume at 12 breaths per minute. The ventilating gas mixture was oxygen 16% in nitrous oxide, and oxygen was insufflated at flow rates of 2, 4, 6, 8, 10, 12 or 14 litres per minute. The rate of rise of FAO2 and the equilibrium FAO2 attained were greatest at high oxygen inflow rates. The relationship between oxygen flow and FAO2 was not linear however, and an oxygen flow rate of 10 l/min was adequate to generate FAO2's around 50% with either ventilatory pattern. The equilibrium FAO2 achieved was greater with smaller tidal volumes and with larger mask deadspace. We also found that several breaths were required for equilibration of FAO2 during each trial, supporting recommendations that several breaths should be given on commencement of artificial ventilation during cardiopulmonary resuscitation.

Equipment Design↗
PubMed1993

The use of carbon dioxide as an insufflation agent in barium enema--does it have a role?

A double blind prospective study was undertaken to evaluate the benefit of using carbon dioxide in double contrast barium enema (DCBE). 142 consecutive patients referred for DCBE were randomly allocated to receive either air or carbon dioxide (CO2) as the insufflation agent. The use of CO2 reduced the incidence of immediate and delayed severe pain from 31% to 12.5% and from 12.9% to 4.2% respectively. There was a statistically significant higher incidence of delayed severe pain in the younger age group as found in previous studies. Post-evacuation films showed that there was less residual gas after CO2. The quality of the DCBE was unchanged. We urge the more widespread use of CO2 as insufflation agent in DCBE.

Adult↗
PubMed1997

A comparison of thoracoscopic talc insufflation, slurry, and mechanical abrasion pleurodesis.

The purpose of this study was to compare the anatomic and histopathologic results of four different methods of pleurodesis in 10 dogs. Each animal was randomly assigned to receive two of the following methods of pleurodesis: thoracoscopic talc insufflation (poudrage), talc slurry administration, focal gauze abrasion by limited thoracotomy, and mechanical abrasion by thoracoscopy using a commercially available pleural abrader. Animals were killed 30 days after pleurodesis. At autopsy, the efficacy of pleurodesis was graded by evaluating the gross appearance of each pleural cavity and lung (pleurodesis score), and by determining the extent of adhesion formation (obliteration grade). Pleural and lung biopsy specimens were obtained from the areas most representative of adhesion formation for histopathologic evaluation. Pleurodesis scores (on a scale of 0 to 4) were 3.0 +/- 0.7 for talc poudrage (p < 0.05 when compared with talc slurry), 2.2 +/- 1.7 for thoracotomy, and 1.6 +/- 1.1 for talc slurry. Adhesions produced by gauze abrasion during thoracotomy were mostly peri-incisional. Thoracoscopic pleural abrasion using the pleural abrader was uniformly unsatisfactory. Granulation tissue formation was greatest in both talc models. The degree of parietal pleural thickening was greatest in the talc slurry model, but fibrosis and inflammation occurred mostly in gravity-dependent areas within the pleural cavity. Although differences were not statistically significant, thoracoscopic talc insufflation consistently produced the most widespread, firm fibrotic adhesions as evidenced by higher obliteration grades.

Animals↗
PubMed2003

Heroin insufflation as a trigger for patients with life-threatening asthma.

STUDY OBJECTIVES: To determine the prevalence of self-reported, heroin-associated asthma symptoms among inner-city patients treated for life-threatening asthma, and to compare the rates of drug use between ICU patients with asthma and ICU control patients with diabetic ketoacidosis (DKA). DESIGNS: Study 1 was a sequential case series of patients requiring ICU admission for asthma (January to June 1999). Study 2 was a retrospective, case-control study of drug use among asthma patients and control subjects with DKA requiring ICU care (1997 to 1998). SETTING: Inner-city, public hospital ICU. PATIENTS: Twenty-three patients (26 ICU admissions) with asthma (age range, 16 to 50 years) admitted to the ICU from January to June 1999, and 84 patients (104 ICU admissions) with asthma and 42 patients with DKA (age range, 15 to 50 years) admitted to the ICU during 1997 to 1998. Outcomes studied: Self-reported, heroin-associated exacerbations, history of heroin or cocaine use, and urine drug screen (UDS) results. MEASUREMENTS AND RESULTS: In the sequential ICU admissions, 13 of 23 patients (56%) described asthma exacerbations associated with heroin insufflation. In the case-control study, asthmatics were significantly more likely to report heroin use (41.3% vs 12.5%; p = 0.006) and had a significantly higher prevalence of UDS results positive for opiates (60% vs 7%; p = 0.001) compared to subjects with DKA. The rates of cocaine use by history and UDS results did not differ significantly between the two groups. CONCLUSIONS: At least since 1997, heroin insufflation is a common asthma trigger in this inner-city ICU and should be considered in the care of patients with life-threatening asthma.

Adolescent↗
PubMedDate not supplied

Accidental overdose of insufflated colchicine.

An accidental overdose of colchicine by nasal insufflation occurred when the colchicine was mistaken for methamphetamine. Colchicine insufflation is not believed to be a common practice among drug abusers; however, its physical appearance was similar enough to methamphetamine for it to be mistaken for that drug of abuse. In this case a 29-year-old White man presented to the emergency room 3 days after he 'snorted' approximately 200mg of colchicine powder. The colchicine was used as a 'root stimulator' in gardening by the patient's brother and stored in the same cabinet as the methamphetamine. Within 24 hours of exposure the patient began experiencing gastrointestinal distress and myalgia, which eventually prompted him to seek medical attention. The clinical course included hypocalcaemia (69 mg/L--day 5), hypophosphataemia (10 mg/L--day 5) and thrombocytopenia (19 X 10(3)/mm3 - day 8), all of which are consistent with colchicine toxicity. The patient improved with supportive care and electrolyte replacement, and was discharged after an 8-day hospitalisation.

Adult↗
PubMed1979

Acid-base balance during laparoscopy. The effects of intraperitoneal insufflation of carbon dioxide and nitrous oxide on acid-base balance during controlled ventilation.

During laparoscopy the carbon dioxide used to achieve a pneumoperitoneum is absorbed from the peritoneal cavity into the blood. The object of the present study was to clarify certain aspects concerned with anesthetic and ventilatory techniques, mostly in connection with the comparison between the effects of insufflation of either carbon dioxide or nitrous oxide. Anesthesia included ventilation with a volume controlled ventilator in curarised patients. Respiratory volumes were calculated according to the patient's body area. The results show a sharp rise in PaCO2 and a fall in pH after intraperitoneal insufflation with carbon dioxide, while no changes were observed when nitrous oxide was used. The clinical consequences of these findings are discussed.

Acid-Base Equilibrium↗
PubMed1988

[Oxygen partial pressure after rectal oxygen insufflation-- experimental animal studies].

An oxygen diffusion through the mucosa of the colon into the vessels of the submucous coat was provable after rectal insufflation of an oxygen-gas mixture by animal experimental investigations in rabbits. Significantly higher pO2 values in the blood of the mesocolon veins, the portal vein, in the arterial and venous mixed blood of the liver parenchyma, and in the arterial vessels of the mesocolon are measurable after rectal application of oxygen during a time of 40 minutes. The oxygen therapy after rectal oxygen insufflation is established by animal experiments.

Administration, Rectal↗
PubMed1983

Respiration maintained by externally applied vibration and tracheal insufflation in the cat.

It was reported recently that adequate gas exchange could be maintained in patients and experimental animals by applying very high-frequency (15 Hz), low-volume oscillations at the upper airways. This report deals with a new mode of high-frequency ventilation, in which gas exchange is achieved in paralyzed cats by externally vibrating the chest wall. These vibrations, which alone caused very small-volume (less than 0.5 ml) oscillations at the tracheal opening, maintained gas exchange at normal PaCO2 for hours when coupled with tracheal air insufflation. PaCO2 values as low as 15 torr could be achieved by increasing the insufflation rate. Vibration frequencies in the range of 20-45 Hz were equally effective. The method required little or no continuous positive airway pressure, caused little elevation of mean tracheal pressure, and no consistent changes in arterial and central venous pressures during ventilation. In addition to the potential merits of this method of ventilation, the described vibrations seem to considerably reduce the anatomic dead space and as such may assist conventional methods of artificial ventilation or even spontaneous breathing when rapid and shallow.

Animals↗
PubMed1984

Insufflated red cells protect lungs from hyperoxic damage: role of red cell glutathione in scavenging toxic O2 radicals.

Hyperoxia-mediated pulmonary damage may involve formation of toxic oxygen species such as superoxide, hydrogen peroxide, and hydroxyl radical. Intact red cells evidently scavenge these when insufflated in small numbers into the tracheobronchial tree of rats. Such manipulation protects hyperoxic rats for prolonged periods of time and preserves normal pulmonary histology. Of several potential oxygen metabolite scavengers, a role for red cell glutathione seems particularly likely. It has not escaped our attention that an ironic, and previously unsuspected, connotation of our results emerges: namely, that a small degree of spontaneous alveolar bleeding, which is not an uncommon feature in respiratory distress situations, may actually be beneficial to patients--particularly those ventilated with excessive inspired oxygen concentrations. If confirmatory studies from other laboratories are forthcoming, the tracheal insufflation of autologous red cells in ventilated patients might be considered in the future.

Animals↗
PubMed1981

[The influence of transtympanal gas insufflation on the tympanogram. Studies in cases of retracted or adhesive tympanic membranes and in middle ear models (author's transl)].

Transtympanal insufflation of the inert gas SF6 in cases of atelectasis mostly makes the atrophic tympanic membrane shift lateral, thus reaching a better functional position. The pathological tympanogram may become almost normal after insufflation. Model studies show that this is not only caused by equalisation of possible negative pressures but also by the enlargement of the middle ear volume and the improved position of the tympanic membrane.

Absorption↗