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At least 487 records · Page 27Linked to original sources
PubMed1997

Clinical application of transorotracheal tube tracheal insufflation of oxygen in patients undergoing simple video-assisted thoracoscopic surgery.

Video-assisted thoracoscopic surgery (VATS) has been performed during ganglionectomy and bullectomy and usually requires a collapsed or immobilized lung. Transtracheal insufflation of oxygen (TRIO) maintains an immobilized lung, adequate oxygenation, and partial CO2 elimination but has never been used for VATS. We have simplified the TRIO design with a catheter inserted through the lumen of the orotracheal tube in what we call "transorotracheal tube TRIO" (TRIO-TOTT) and investigated its clinical use on simple VATS. Eleven patients undergoing bullectomy for primary simple pneumothorax (PSP) were studied. During the performance of VATS, a 12-gauge suction catheter was inserted as our modification and connected to the gas outlet of an anesthetic machine. The flow rate of oxygen was maintained at 10 L/min. Blood gas was collected prior to TRIO-TOTT, during TRIO-TOTT at 5, 10, 15, and 20 min, and 5 min after TRIO-TOTT. The blood gas data showed excellent oxygenation while the PaCO2 increased at a rate of 1.2 mm Hg/min compared to 3-4 mm Hg/min for apnea oxygenation. After 20 min, the mean +/- SEM PaO2 and PaCO2 were 428 +/- 27 and 65.0 +/- 2.6 mm Hg, respectively. We conclude that TRIO-TOTT is a simple, safe, and effective ventilation method for simple VATS.

Adolescent↗
PubMed1985

Tracheal insufflation of O2 (TRIO) at low flow rates sustains life for several hours.

The emergency management of respiratory arrest can be a difficult problem. The authors hypothesized that tracheal insufflation of O2 (TRIO) at low flows could provide adequate oxygenation and sufficient CO2 elimination to sustain life until more definitive (but more difficult to implement) measures could be applied. Therefore, 10 anesthetized, paralyzed dogs (15.9-48.2 kg), initially ventilated with conventional mechanical ventilation (CMV) using room air, were studied. CMV was stopped and a 1- or 5-mm id catheter with a constant flow (V) of O2 ranging from 0.2 to 3.0 l/min was inserted to within 1 cm of the carina. With all flow rates, PaO2 and PaCO2 initially increased with time; the rate of increase of PaO2 was greater and that of PaCO2 was less, with increasing V. In three dogs studied at flow rates of 2.0 or 3.0 l/min, arterial blood gases reached a plateau after about 2 h: pH = 6.87; PCO2 = 164 mmHg; and PO2 = 363 mmHg (mean values). These studies were stopped at between 4 and 5 h, with no dogs showing any signs of cardiovascular or other decompensation. Results in which catheter position was studied indicated that as long as the catheter tip was at or past the carina, gas transport was similar to that observed when the catheter tip was 1 cm proximal to the carina. The authors conclude that TRIO at low flow rates can produce sufficient gas exchange to support life for prolonged periods in apneic dogs.

Animals↗
PubMed1984

Air insufflation of the colon as an adjunct to computed tomography of the pelvis.

Air insufflation of the colon as an adjunct to pelvic CT examinations was performed in 49 patients for evaluation of a known or suspected pelvic mass or in follow-up of treated pelvic tumors. This safe, simple method of colonic visualization clearly outlines the rectosigmoid colon and permits a reliable assessment of the mucosa, wall thickness, and extrinsic abnormalities, thereby improving diagnostic accuracy in staging pelvic malignancy and evaluating pelvic pathology.

Air↗
PubMed1996

Near-fatal status asthmaticus induced by nasal insufflation of cocaine.

Asthma and cocaine abuse are both common. While cocaine has been associated with numerous pulmonary complications, only smoking cocaine has been clearly linked to the precipitation of life-threatening exacerbations of asthma. We report a case in which nasal insufflation of cocaine ("snorting") triggered a near-fatal asthmatic attack.

Administration, Intranasal↗
PubMed1985

Protection against lethal hyperoxia by tracheal insufflation of erythrocytes: role of red cell glutathione.

Intact erythrocytes placed into the tracheobronchial tree of hyperoxic rats dramatically improved their chances for survival. Over 70 percent of the animals so treated survived more than 12 days during continuous exposure to 95 percent oxygen, whereas all of the control animals died within 96 hours. Lungs from erythrocyte-protected rats showed almost none of the morphologic damage suffered by untreated animals. Erythrocytes containing cyanomethemoglobin were as beneficial as normal erythrocytes, but cells in which glutathione was partially blocked were significantly less protective. Analogous results were obtained in vitro: 51Cr-labeled target cells released 70 to 90 percent of their label when exposed briefly to hydrogen peroxide or to toxic oxygen species generated by phorbol ester-stimulated neutrophils. Addition of intact erythrocytes decreased release by approximately 75 percent, but significantly less than this if red blood cell glutathione was partially blocked. These results suggest that insufflated erythrocytes, through their recyclable glutathione, protect rats from toxic oxygen species engendered by hyperoxia.

Animals↗
PubMed1971

Cardiovascular effects of peritoneal insufflation of carbon dioxide for laparoscopy.

We have investigated, in 13 artificially ventilated and anaesthetized patients, the cardiovascular effects of peritoneal insufflation of carbon dioxide preparatory to laparoscopy. Stepwise increases of intra-abdominal pressure up to a maximum of 25 cm H(2)O were accompanied by increases of airway pressure, intrathoracic pressure, central venous pressure, and femoral venous pressure and by signs of cardiovascular stimulation with mild tachycardia and hypertension. End-tidal carbon dioxide tension rose only slightly. The anaesthetic technique used provided good surgical conditions; our results suggest that it does not impose undue strain on the homoeostatic ability of the patient's cardiovascular system.

Adult↗
PubMed1994

Protection against oxygen toxicity by tracheal insufflation of endotoxin: role of Mn SOD and alveolar macrophages.

Endotoxin and the cytokines, tumor necrosis factor and interleukin-1, are known to protect adult rats against O2 toxicity. However, whether the effect of endotoxin is mediated through its direct effect on lung cells or through cytokines is not clear. In this study, we demonstrated that endotoxin at a dosage of 5 micrograms/rat (14-20 micrograms/kg) attenuated O2-induced pulmonary injury and markedly prolonged the survival of rats exposed to 100% O2. Endotoxin was more protective when given by intratracheal insufflation or intravenous injection than by intraperitoneal injection. The endotoxin-induced O2 tolerance was associated with a selective enhancement of pulmonary manganese superoxide dismutase, but not Cu,Zn SOD, mRNA. In addition, depletion of 84% rat alveolar macrophages by liposome-encapsulated dichloromethylene diphosphonate, resulted in a marked reduction (86%) of endotoxin-induced release of tumor necrosis factor into the alveolar space. However, endotoxin was still protective in these alveolar macrophage-depleted animals.

Animals↗
PubMed1982

Rapid ventilatory responses to changes in insufflated CO2 in awake roosters.

The ventilatory responses to pulses or steps in the fraction of CO2 in the insufflated gas stream (FICO2) in awake, unidirectionally ventilated White Leghorn roosters (Gallus domesticus) were studied. Within 0.2-0.5 s of the change in FICO2 at the syrinx, a change in inspiratory or expiratory flow occurred. Increases in FICO2 increased flow and tidal volume (VT), whereas decreases in FICO2 decreased flow and VT. Expiratory duration (TE) was markedly prolonged by decreases in FICO2 and shortened by increases. Inspiratory duration was affected little by FICO2 changes. The TE response to pulses of FICO2 (0.2-0.4 s duration) revealed a time dependency such that a maximum effect occurred when the pulses arrived at the syrinx at approximately midexpiration. The magnitudes of the responses were approximately proportional to the amplitude and duration of the FICO2 changes, but decreases in FICO2 had greater effects than increases. A likely receptor site for these responses is the intrapulmonary chemoreceptors, which appear to function in a reflex controlling airflow and timing of the ongoing breath.

Animals↗
PubMed1996

Distal effects of tracheal gas insufflation: changes with catheter position and oleic acid lung injury.

We separated distal (turbulence-related) and proximal (dead space washout-related) effects of tracheal gas insufflation (TGI) by comparing the effects of straight and inverted catheters. We reasoned that the inverted catheter was unlikely to remove CO2 from conducting airways distal to its orifice. In six normal dogs during TGI at 10 l/min, advancing the catheters from 10 to 1 cm above the main carina decreased dead space volume by 29 +/- 12 and 12 +/- 6 ml (P < 0.04) with the straight and inverted catheters, respectively. By comparison, the tracheal volume between 10 and 1 cm above the carina was 15 +/- 2 ml. In another set of dogs (n = 5), we examined the distal effects of TGI before and after oleic acid-induced lung injury. During TGI at 10 l/min before and after oleic acid injury, the differences in arterial PCO2 between the straight and inverted catheters were 5 +/- and 9 +/- 6 Torr (P < 0.18), respectively. Our data suggest that distal effects of TGI become more pronounced as the catheter tip is positioned closer to the main carina. The distal effects of TGI were not diminished after oleic acid injury when minute ventilation was maintained constant.

Animals↗
PubMed2006

Transpulmonary pressures and lung mechanics with glossopharyngeal insufflation and exsufflation beyond normal lung volumes in competitive breath-hold divers.

Throughout life, most mammals breathe between maximal and minimal lung volumes determined by respiratory mechanics and muscle strength. In contrast, competitive breath-hold divers exceed these limits when they employ glossopharyngeal insufflation (GI) before a dive to increase lung gas volume (providing additional oxygen and intrapulmonary gas to prevent dangerous chest compression at depths recently greater than 100 m) and glossopharyngeal exsufflation (GE) during descent to draw air from compressed lungs into the pharynx for middle ear pressure equalization. To explore the mechanical effects of these maneuvers on the respiratory system, we measured lung volumes by helium dilution with spirometry and computed tomography and estimated transpulmonary pressures using an esophageal balloon after GI and GE in four competitive breath-hold divers. Maximal lung volume was increased after GI by 0.13-2.84 liters, resulting in volumes 1.5-7.9 SD above predicted values. The amount of gas in the lungs after GI increased by 0.59-4.16 liters, largely due to elevated intrapulmonary pressures of 52-109 cmH(2)O. The transpulmonary pressures increased after GI to values ranging from 43 to 80 cmH(2)O, 1.6-2.9 times the expected values at total lung capacity. After GE, lung volumes were reduced by 0.09-0.44 liters, and the corresponding transpulmonary pressures decreased to -15 to -31 cmH(2)O, suggesting closure of intrapulmonary airways. We conclude that the lungs of some healthy individuals are able to withstand repeated inflation to transpulmonary pressures far greater than those to which they would normally be exposed.

Adult↗
PubMed1992

Tracheal gas insufflation during pressure-control ventilation. Effect of catheter position, diameter, and flow rate.

In the setting of acute lung injury, ventilatory strategies that adjust minute ventilation (VE) to achieve eucapnia often lead to alveolar rupture or damage. Tracheal gas insufflation (TGI) reduces the VE requirements of conventional mechanical ventilation by decreasing the effective dead-space fraction (VD/VT) of each breath. We studied the effect of catheter flow rate (Vcath) and position as well as catheter tip diameter and configuration on CO2 elimination during TGI-augmented pressure-controlled ventilation (PCV) in normal dogs. We studied three catheter positions (1, 5, and 10 cm above the carina) at Vcath of 2, 5, and 10 L/min (n = 6). When the catheter tip was positioned 1 cm above the carina, PaCO2 decreased significantly from a baseline (PCV alone) of 67 +/- 10 mm Hg to 52 +/- 11, 43 +/- 9, and 32 +/- 7 mm Hg (p < 0.05) at Vcath of 2, 5, and 10 L/min, respectively. For the same Vcath values, positioning the catheter tip 10 cm above the carina increased PaCO2 to 54 +/- 15, 46 +/- 12, and 40 +/- 11 mm Hg. Advancing the catheter tip 2 cm below the carina did not improve PaCO2 significantly (n = 3). At a catheter position of 1 cm above the carina and a Vcath of 10 L/min, changing the luminal inner diameter (1.5 versus 3.0 mm) or tip configuration (open tip versus occluded tip with two side holes) of the catheter did not change PaCO2.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Insufflation esophagoscopy.

A new electroscope has been designed from the conventional Haslinger tubes. The new rigid scope combines the advantage of air insufflation in the flexible system with the therapeutic possibilities of the rigid tubes and is trustworthy in the following esophageal procedures; a) finding entrance of severe strictures; b) introducing nasogastric feeding tubes; c) extraction of foreign bodies; d) tumor coagulation/spur in hypopharyngeal diverticuli; e) washing and suction in cases with severe food retention; f)making tumor smears in patients with clotting disorders; g) taking substantial biopsies with an optical forceps, and h) objective photodocumentation of esophageal pathology.

Esophagoscopes↗
PubMed1993

Use of peritoneal insufflation to displace the small bowel during pelvic and abdominal radiotherapy in carcinoma of the cervix.

Peritoneal insufflation is a technique which reliably displaces small bowel from pelvic and abdominal radiotherapy fields with the aim of reducing bowel reactions which limit the dose of radiation applied to these sites. Use of this technique in five patients undergoing radiotherapy for advanced carcinoma of the cervix, and the degree of bowel displacement resulting, dosimetry, acute reactions and tolerability of the technique are presented, with discussion of the possibility of future escalation in radiotherapy dose.

Female↗
PubMed1980

Jet insufflation anesthesia for endolaryngeal surgery.

The ideal anesthetic in endolaryngeal surgery provides a quiet completely unobstructed larynx in a patient who is comfortable and has respiratory functions maintained. Dissatisfaction with the intubation and venturi techniques has led to the use of a high pressure jet insufflation method. The results of this study have shown that anesthetically this technique is safe for a wide range of patients and endoscopic procedures. Laryngologically, the absence of glottic obstruction has broadened the scope of endoscopic procedures performed under general anesthesia.

Anesthesia↗
PubMed1985

Jet insufflation anesthesia for endolaryngeal laser surgery: a review of 318 consecutive cases.

A series of 318 patients utilizing the jet insufflation technique for laser laryngeal anesthesia was studied. The technique utilizes a foil wrapped catheter placed below the vocal cords and attached to the Sanders ventilating adapter. Two pneumothoraces in children, one dental injury and one tube ignition were noted--all without permanent sequelae. Subsequent modification in technique prevented recurrence of these complications. The results indicate that this is a safe technique for laryngeal laser surgery, providing excellent visualization of the larynx while maintaining good oxygenation and airway control.

Anesthesia, Endotracheal↗
PubMed1999

[Does insufflation of the abdomen in laparoscopic surgery affect acid-base and ventilatory parameters?].

The cardiopulmonary and metabolic changes experienced by patients undergoing laparoscopic cholecystectomy with CO2 pneumoperitoneum are not well understood. The purpose of this study is to determine changes of basal parameters during laparoscopy and evaluate their prognostic value. One hundred patients (26 obese, 39 older than 60 years, 7 obese and older than 60) undergoing laparoscopic cholecystectomy for uncomplicated cholecystolithiasis were included in the study. Arterial blood gases, respiratory and ventilatory parameters, heart rate, blood pressure were determined before the induction of pneumoperitoneum, at the peak of operation and after exsufflation. The obtained variables were statistically evaluated. Pneumoperitoneum caused significant hypercapnia and a decrease of pH accompanied with increase of expiratory CO2 concentration, which continued after exsufflation (p < 0.001). The changes were more expressed in older and obese patients and were solely of a respiratory type. No significant changes were observed in the heart rate, blood pressure, minute ventilation, PaO2, SaO2, base excess. Although changes were highly significant, there was no impact on clinical status--all patients survived without problems. The authors conclude that observed increase of carbon dioxide levels and decrease of pH had no impact on survival of patients. Changes were caused mostly by CO2 absorption from the abdominal cavity. Laparoscopic cholecystectomy is a safe and effective procedure even in older and obese patients, especially when insufflation is as low as possible.

Acid-Base Equilibrium↗