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At least 505 records · Page 28Linked to original sources
PubMed1991

[Peroperative massive pulmonary embolism of tumoral origin. Value of extensive monitoring].

A case is reported of a 47-year-old female patient who suffered from massive tumour embolism during a nephrectomy for a renal carcinoma invading the inferior vena cava. Intraoperative monitoring consisted in direct blood pressure measurement (radial artery cannula), central haemodynamic monitoring (Swan-Ganz catheter), pulse oximetry and capnography. During the surgical manipulation of the suprahepatic vena cava, Petco2 suddenly decreased (from 25 mmHg to 14 mmHg), together with Spo2 (from 99% to 89%), and the mean pulmonary arterial pressure increased from 18 mmHg to 40 mmHg. The drop in arterial blood pressure to 50/30 mmHg, initiated an immediate sternotomy. After clamping the superior and inferior venae cavae, numerous tumour fragments were removed from the pulmonary artery. Cardiac activity restarted after internal cardiac massage, 1 mg adrenaline, 1 g calcium chloride and 150 mmol of molar sodium bicarbonate. The whole procedure lasted 30 min. Arterial blood pressure became stable at 110/50 mmHg, pulmonary arterial and wedge pressures at 20 and 5 mmHg. The Spo2 increased to 98%, and Petco2 to 25 mmHg. The nephrectomy was then carried out, the patient being given 5 micrograms.kg-1.min-1 dobutamine and 3 micrograms.kg-1.min-1 dopamine. At the end of surgery, systolic blood pressure was 120 mmHg, mean pulmonary arterial pressure 25 mmHg, and PaCO2 34 mmHg. The patient left the intensive care unit after twelve days. After one year of follow-up, no complication had occurred. The value of cardiopulmonary bypass in nephrectomy for renal carcinoma invading the vena cava, or the renal vein, is discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1994

[Use of Diprivan in ENT and stomatology].

Irrespective of the type of surgery, patient monitoring, including ECG-automated non-invasive blood pressure measurements, SpO2, FIO2 and capnography, is compulsory. Sedation: no initial bolus injection of propofol; continuous infusion of propofol at a rate of 1 to 4 mg.kg-1.h-1, using a syringe pump, combined with a short-acting opioid such as alfentanil. General anaesthesia: initial bolus injection of propofol between 2 and 3.5 mg.kg-1, combined with 10 mg of lidocaine in the same syringe; maintenance with a syringe pump: 6 to 9 mg.kg-1.h-1 combined with an opioid, with or without coadministration of muscle relaxants. Intubation avoiding respiratory depression: syringe pump with a fast infusion rate (50 to 100 mg.min-1), which allows induction with propofol and intubation without co-administration of muscle relaxants.

Adenoidectomy↗
PubMed2000

[Management of severe head-injured patients in the first 24 hours. Resuscitation and initial diagnostic strategy].

Limitation of secondary insults after severe head injury is a permanent concern during the early phase of head trauma management. The objectives are to maintain mean arterial pressure between 80 and 100 mmHg, to avoid hypoxaemia, and to maintain arterial PCO2 near to 35 mmHg. Volume loading can be necessary to improve arterial pressure, and is carried out with isotonic critalloid (NaCl 9/1000) or colloids, with the exclusion of all hypotonic solutions (Ringer lactate or glucose). The use of catecholamines is reserved for patients with unstable haemodynamics despite an adequate volume loading. The rapid sequence induction is recommended for endotracheal intubation and is followed by continuous analgesia-sedation to keep patient-ventilator dysynchrony, but without compromising haemodynamic objectives. Mannitol is used in case of life-threatening intracranial hypertension. Conversely, specific treatment of intracranial hypertension, especially hypocapnia, is not recommended. Initial diagnostic procedures include cerebral tomodensitometry (TDM). However, TDM may be delayed in case of haemorrhage, which requires a rapid treatment. Intrahospital transport for additional explorations risks secondary insults, and thus requires close monitoring to detect and treat in due time all adverse events. This monitoring includes invasive arterial blood pressure assessment, use of continuous capnography and repeated arterial blood gas measurements. The usefulness of transcranial Doppler for initial management of head-trauma patients needs further evaluation.

Brain Injuries↗
PubMed2002

The Closed Claims Project. Has it influenced anesthetic practice and outcome?

Although there are intrinsic limitations in the analysis of closed malpractice claims, the Closed Claims Project has identified important anesthetic complications and mechanisms of injury and stimulated research in problem areas. The decrease in severity of injury in anesthesia malpractice claims suggests that anesthesia safety has improved since the establishment of monitoring standards using pulse oximetry and end-tidal capnography.

Anesthesiology↗
PubMed2002

Neuroanesthesia. Innovative techniques and monitoring.

Advances in neuromonitoring have provided insights into neurologic function during anesthesia. Despite the limitations and necessary caution when using intraoperative monitors to interpret neural function, these technologies have been definite steps in the right direction for assessing neural integrity and level of consciousness during anesthesia. The techniques discussed minimize the adverse sequelae of a variety of neurosurgical and orthopedic procedures, reducing the morbidity rates/risks in the perioperative period. Furthermore, it is likely that such monitoring will become a standard of care, similar to other monitoring standards such as pulse oximetry and capnography. Accurate and reliable monitoring is essential, and on-going large prospective studies comparing the processed EEG or evoked potential with definable end points in both adult and pediatric populations will be necessary. The use of monitoring, such as the BIS, may improve cost efficiency by reducing the total amount of drug used to maintain anesthesia, as well as enhance recovery. A danger in this process, however, is the potential for public opinion, outside regulatory bodies, or medico-legal implications to drive change and enforce standards of care before appropriate data are available.

Anesthesia↗
PubMed2001

Pressure controlled versus volume controlled ventilation with laryngeal mask airway.

STUDY OBJECTIVE: To quantify the impact on peak airway pressure of pressure-controlled and volume-controlled ventilation during Laryngeal Mask Airway (LMA) use. DESIGN: Prospective, crossover clinical study. SETTING: University-affiliated hospital. PATIENTS: 32 ASA physical status I and II patients undergoing general anesthesia with the LMA. INTERVENTIONS: Patients were ventilated for three minutes both with pressure-controlled and volume-controlled ventilation, provided that tidal volume (V(T) ) and inspiratory time (It) were constant. MEASUREMENTS AND MAIN RESULTS: The monitored parameters were electrocardiography, arterial blood pressure, pulse oximetry, capnography, neuromuscular transmission, airway pressure and flow, and concentration of ventilated vapors and gases. The actually delivered V(T) was similar with both types of ventilation (volume-controlled = 0.67 +/- 0.13 lt, pressure-controlled = 0.67 +/- 0.14 lt; p = 0.688). Peak airway pressure was lower during pressure-controlled ventilation (14.6 +/- 3.5 cmH(2)O) than during volume-controlled ventilation (16 +/- 4 cmH(2)O) (p < 0.001). Furthermore, we noted that the higher the airway pressure with volume-controlled ventilation, the greater was the reduction in airway pressure during pressure-controlled ventilation. CONCLUSIONS: Pressure-controlled rather than volume-controlled ventilation can improve the effectiveness of mechanical ventilation in patients with high airway pressure.

Adult↗
PubMed1996

Active compression-decompression cardiopulmonary resuscitation does not improve survival in patients with prehospital cardiac arrest in a physician-manned emergency medical system.

OBJECT: To examine the efficacy of a new method of cardiac resuscitation, active compression-decompression cardiopulmonary resuscitation (ACD CPR), in prehospital cardiac arrest. DESIGN: Prospective, randomized, controlled trial. SETTING: Physician-manned Mobile Intensive Care Unit (MICU) of a university hospital, serving a population of 200,000. PARTICIPANTS: Adult patients with prehospital nontraumatic cardiac arrest treated by the MICU. INTERVENTIONS: Patients were randomized to standard chest compression according to American Heart Association (AHA) recommendations (group 1, 30 patients) or to the new technique (group 2, 26 patients). ACD was performed by use of a hand-held suction device. In both groups, advanced life support was performed as recommended by the AHA. MEASUREMENTS AND MAIN RESULTS: Rate of patients regaining a spontaneous circulation (ROSC), hospital discharge rate, and mean carbon dioxide content during resuscitation were recorded. ROSC rates in groups 1 and 2 were 40% and 38.5%, respectively. Four patients (13.3%) in group 1 and three patients (11.5%) in group 2 were discharged (group 1 v group 2: n.s.). Anatomic conditions precluded the application of ACD CPR in 5 patients. The new technique was found to impose greater physical efforts than STD CPR. Capnography was performed in 23 patients (mean value: STD CPR: 11.9 +/- 4.7 mmHg, ACD CPR: 13.7 +/- 4.9 mmHg [n.s.]). CONCLUSIONS: ACD CPR did not improve, outcome and practical performance was complicated. Therefore, this technique should not be performed routinely, or without strict supervision in prehospital cardiac arrest.

Adult↗
PubMed1999

Anesthetic considerations for laser, laparoscopy, and thoracoscopy procedures.

Laser surgery and laparoscopy are two relatively new surgical techniques gaining popularity in veterinary medicine, which require special consideration when being performed on the anesthetized patient. For laser surgery, consideration must be given to the possibility of atmospheric contamination, inappropriate energy transfer, eye injury, perforation of a vessel or anatomic structure, perforation of the endotracheal tube, and fire. The primary concern with laparoscopy and thoracoscopy is the creation of a pneumoperitoneum or pneumothorax, which can result in (1) hypercarbia and inadequate ventilation, (2) poor cardiac output and systemic blood pressure, and (3) gas embolism. To minimize complications, patients should be placed on positive pressure ventilation, be well hydrated before and during the procedure, and be thoroughly monitored (ECG, capnography, pulse oximetry.

Anesthesia↗
PubMed2003

Bronchoscopy in paediatric intensive care.

Bronchoscopy is a highly versatile technique in the context of intensive care and has many potentially valuable indications. Safety is of paramount importance and the risks in critically unstable patients are correspondingly greater than in more stable children. The main contraindication to bronchoscopy is if it will provide no useful information. The procedure is obviously more risky in children with severe hypoxia, uncontrolled bleeding diathesis, cardiac failure or severe pulmonary hypertension. Monitoring should include at least oxygen saturation, blood pressure (ideally by continuous, invasive monitoring) and preferably capnography. Indications for bronchoscopy in paediatric intensive care include endobronchial toilet, sometimes instilling recombinant human DNAase even in children who do not have cystic fibrosis; checking tube patency and position; assisting in a difficult intubation or tube change; achieving the selective intubation of a main bronchus; the diagnosis and management of ventilator-associated pneumonia or the ventilated, immunocompromised host; the assessment of lobar collapse or focal hyperinflation; airway stent assessment; assessment of stridor on extubation and the diagnosis of any associated disease. New iatrogenic complications are also likely to be discovered. The procedure is very safe if performed by experienced operators with back-up from doctors skilled in airway management and the monitoring of sick children.

Bronchoscopes↗
PubMed2003

[Mechanical ventilation monitoring: gas analysis and acid base balance].

Analysis of blood gases and acid-base status is essential for monitoring mechanical ventilation. The most commonly used methods are based on intermittent blood gases, continuous pulse oximetry and capnography, and less frequently on continuous intraarterial gasometry. The most useful parameters for analyzing oxygenation are PaO2, hemoglobin saturation, PaO2/FiO2 ratio, oxygenation index, PaCO2 to evaluate ventilation, and pH and base excess to analyze acid-base status. A method for analyzing the results of blood gases and derivative parameters is recommended and the interpretation of different states of acidosis and alkalosis is discussed.

Acid-Base Equilibrium↗
PubMed2004

Difficult airway equipment in departments of emergency medicine in Ireland: results of a national survey.

BACKGROUND AND OBJECTIVE: Adverse effects associated with difficult airway management can be catastrophic and include death, brain injury and myocardial injury. Closed-malpractice claims have shown prolonged and persistent attempts at endotracheal intubation to be the most common situation leading to disastrous respiratory events. To date, there has been no evaluation of the types of difficult airway equipment currently available in Irish departments of emergency medicine. The objective of this survey was to identify the difficult airway equipment available in Irish departments of emergency medicine. METHODS: Departments of emergency medicine in the Republic of Ireland with at least one dedicated Emergency Medicine consultant were surveyed via telephone. RESULTS: All of the departments contacted held at least one alternative device on site for both ventilation and intubation. The most common alternative ventilation device was the laryngeal mask airway (89%). The most common alternative intubating device was the surgical airway device (100%). CONCLUSIONS: Irish departments of emergency medicine compare well with those in the UK and USA, when surveyed concerning difficult airway equipment. However, we believe that this situation could be further improved by training inexperienced healthcare providers in the use of the laryngeal mask airway and intubating laryngeal mask airway, by placing greater emphasis on the ready availability of capnography and by the increased use of portable difficult airway storage units.

Airway Obstruction↗
PubMedDate not supplied

Where's the tube? Evaluation of hand-held ultrasound in confirming endotracheal tube placement.

INTRODUCTION: The diagnosis of endotracheal tube (ETT) mal-position may be delayed in extreme environments. Several methods are utilized to confirm proper ETT placement, but these methods can be unreliable or unavailable in certain settings. Thoracic sonography, previously utilized to detect pneumothoraces, has not been tested to assess ETT placement. HYPOTHESIS: Thoracic sonography could correlate with pulmonary ventilation, and thereby, help to confirm proper ETT placement. METHODS: Thirteen patients requiring elective intubation under general anesthesia, and data from two trauma patients were evaluated. Using a portable, hand-held, ultrasound (PHHU) machine, sonographic recordings of the chest wall visceral-parietal pleural interface (VPPI) were recorded bilaterally in each patient during all phases of airway management: (1) pre-oxygenation; (2) induction; (3) paralysis; (4) intubation; and (5) ventilation. RESULTS: The VPPI could be well-imaged for all of the patients. In the two trauma patients, right mainstem intubations were noted in which specific pleural signals were not seen in the left chest wall VPPI after tube placement. These signs returned after correct repositioning of the ETT tube. In all of the elective surgery patients, signs correlating with bilateral ventilation in each patient were imaged and correlated with confirmation of ETT placement by anesthesiology. CONCLUSIONS: This report raises the possibility that thoracic sonography may be another tool that could be used to confirm proper ETT placement. This technique may have merit in extreme environments, such as in remote, pre-hospital settings or during aerospace medical transports, in which auscultation is impossible due to noise, or capnography is not available, and thus, requires further scientific evaluation.

Emergency Medical Services↗
PubMed1998

Pressure changes over the anterior neck during tracheal and oesophageal intubation.

Pressure changes were measured on the skin over the cricoid and thyroid cartilages during intubation of the oesophagus or trachea in 21 consenting patients. A 100-ml bag of saline was firmly fixed to the anterior neck and the pressure changes in the bag recorded. Typical and distinctively different pressure patterns for tracheal and oesophageal intubation were recorded. Oesophageal intubation was accompanied by a statistically significantly higher and longer pressure rise and, most characteristically, by an obvious and sustained rise in baseline pressure. This method is, however, neither practical nor recommended for clinical use in detecting accidental oesophageal intubation. Capnography should always be used during tracheal intubation as an ongoing capnographic waveform provides the only guarantee of correct tracheal placement.

Adult↗
PubMed1999

Laryngeal mask for difficult intubation in children.

We present a new intubation technique using an oral preformed tracheal tube passed through a laryngeal mask. Six patients (neonate to six months old) with craniofacial malformations of head and neck and scheduled for reconstructive plastic surgery are the basis of this report. An inhalation induction with increasing doses of halothane in oxygen while maintaining spontaneous ventilation was performed. Once an adequate anaesthetic depth was achieved, a direct laryngoscopy was performed. The epiglottis could not be seen in any of the patients. Anaesthesia was deepened in order to insert the laryngeal mask, size 1 or 2, with an oral preformed 3.5 or 4.0 tracheal tube inside it. Correct position of the mask was confirmed by capnography. The preformed tracheal tube was then advanced 1-2 cm. and its position in the trachea verified. The 15 mm connector was then removed, and an adult intubating stylet was attached to the end of the tracheal tube. The laryngeal mask was removed, holding the stylet and tube in place. Once the mask was removed, the stylet was disconnected, and the 15 mm connector reattached. Our experience was that this takes about 20 to 30 s. We recommended this technique in paediatric patients in which a difficult intubation is foreseen.

Anesthesia, Inhalation↗
PubMed2001

Survey of the use of oesophageal and precordial stethoscopes in current paediatric anaesthetic practice.

BACKGROUND: The aim of the study was to examine the use of oesophageal and precordial stethoscopes for monitoring in current paediatric anaesthetic practice in the UK and Ireland. METHODS: A postal survey of members of the Association of Paediatric Anaesthetist of Great Britain and Ireland was undertaken. RESULTS: One hundred and forty-five questionnaires were returned with a response rate of 67.4%. Some 35.2% of anaesthetists never use an oesophageal or precordial stethoscope and the majority of the remaining 64.8% use one in less than one-third of their practice. CONCLUSION: Use of the stethoscope as a continuous monitor has decreased and most anaesthetists feel it has been superseded by other monitoring. However, almost one-third of anaesthetists recorded critical incidents they had been involved with where an oesophageal or precordial stethoscope detected the incident early. Complications of these monitoring devices were rare and the main factors limiting their use was the presence of better monitoring, such as pulse oximetry and capnography, and lack of availability.

Anesthesia↗
PubMed2001

Continuous axillary block for upper limb surgery in a patient with epidermolysis bullosa simplex.

We report the use of continuous regional block with light general anaesthesia in epidermolysis bullosa simplex. A 4-year-old girl suffering from florid epidermolysis bullosa simplex was scheduled for external fixator (JESS) for manus valgus deformity of the left forearm. Haemoglobin was 7.6 g.dl(-1) and blood chemistry was normal. She had no history of oral bullae, although a younger sibling had died of Bart syndrome with oral lesions. She was sedated with nasal midazolam 0.5 mg.kg(-1). All pressure points were cushioned. Inhalational anaesthesia was given by holding a mask above her face. Only oximetry and capnography were monitored. ECG and noninvasive blood pressure monitoring were avoided. The intravenous cannula was fixed by sutures. An epidural catheter of 0.63 mm OD (21-G) was passed into the axilla for continuous axillary block. Intra- and postoperative course was uneventful with slight bullae at the i.v. site and at the fixator which healed without further damage. The axilla remained free of problems. Continuous peripheral plexus or nerve blocks can be an option in these difficult patients, and can minimize the amount of general anaesthesia along with problems of airway handling and potential subsequent mucosal lesions. The postoperative period was pain free and comfortable.

Anesthesia, Conduction↗
PubMed2002

Resistive inspiratory muscle training in sleep-disordered breathing of traumatic tetraplegia.

OBJECTIVE: To assess the effect of resistive inspiratory muscle training (RIMT) on the static pulmonary function and sleep-induced breathing disorder of individuals with chronic cervical cord injury. DESIGN: Before-after training. SETTING: Home-setting training program. PATIENTS: Fourteen complete traumatic tetraplegic patients (12 men, 2 women; mean age, 41.1 +/- 14y; range, 19-56y) injured for more than 6 months. INTERVENTION: Subjects participated in a 6-week RIMT program for 15 minutes twice daily at a training intensity of 60% of maximum inspiratory pressure (MIP). The participants were reevaluated at the end of 6-week training. MAIN OUTCOME MEASURES: Lung volume, peak expiratory flow (PEF), MIP, and maximum expiratory pressure (MEP) were measured by using a spirometry and inspiratory force meter, respectively. Capnography was used to monitor nocturnal pulse oxyhemoglobin saturation (SpO(2)) and end-tidal carbon dioxide tension level (ETCO(2)) of the patients. RESULTS: The maximum voluntary ventilation (MVV) and MIP of individuals with chronic cervical cord injury substantially improved after RIMT. MIP increased from -68.7 +/- 27.4cmH(2)O to -77.3 +/- 24.0cmH(2)O and MVV rose from 62.7 +/- 33.2L to 73.4 +/- 31.3L (P <.05). Despite increasing from 3.5 +/- 1.8L/s to 4.0 +/- 1.7L/s, PEF was statistically insignificant. For the individuals with improved MIP, the duration of ETCO(2) greater than 48mmHg reduced from 2.2% +/- 3.3% to 1.0% +/- 2.0% of total sleep time (P =.05) and that of SpO(2) less than 90% significantly declined from 1.8% +/- 2.8% to 1.3% +/- 2.4% of total sleep time (P <.05). CONCLUSION: These findings suggest that RIMT can enhance the respiratory muscle strength and endurance of chronic tetraplegia and further ameliorate the sleep-induced breathing disorder. Therefore, RIMT is suggested as a home program for patients with sleep-disordered breathing.

Adult↗
PubMed2001

Is end-tidal CO2 an accurate measure of arterial CO2 during laparoscopic procedures in children and neonates with cyanotic congenital heart disease?

BACKGROUND/PURPOSE: Children with cyanotic congenital heart disease (CCHD) may require laparoscopic procedures. There are no data on the ability of capnography to predict arterial carbon dioxide concentrations (PaCO2) in patients with CCHD during pneumoperitoneum. METHODS: Seven patients (age 1 to 35 months) with CCHD undergoing laparoscopic Nissen fundoplication are presented. Standard general endotracheal anesthesia was administered. The operations were performed either by or in consultation with the cardiac anesthesia team. During each case, concomitant PaCO2 and end-tidal carbon dioxide (ETCO2) measurements were made via an arterial line and capnograph before and after insufflation of the abdomen. The PaCO2-ETCO2 gradients before and during pneumoperitoneum were then compared using a paired Student's t test. RESULTS: There was a statistically significant increase in the PaCO2-ETCO2 gradient (5.7 v 13.4) after insufflation compared with baseline (P <.015). CONCLUSIONS: These preliminary results show that ETCO2 is not a reliable monitor of PaCO2 in patients with CCHD undergoing laparoscopic procedures. The authors feel that close monitoring, including arterial blood gas measurements, and an experienced anesthesia team are necessary to perform laparoscopic procedures in patients with CCHD.

Carbon Dioxide↗