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At least 631 records · Page 35Linked to original sources
PubMed2002

Use of a lighted flexible catheter as a detector for accidental oesophageal intubation through the intubating laryngeal mask: a preliminary study.

We have evaluated the use of a prototype lighted flexible catheter using the transillumination of the light through the soft tissues of the neck, as a detector of the accidental oesophageal intubation during the tracheal intubation through the intubating laryngeal mask. Two hundred patients undergoing general anaesthesia were studied. Accidental oesophageal intubation occurred in 12 patients (6%) during the first intubating attempt and was diagnosed by noting absence of glow on the neck during the tracheal tube advancement and was confirmed by capnography. However, 11/12 (92%) of the above patients were finally intubated successfully, using the lighted flexible catheter. In one patient persistent accidental oesophageal intubation occurred and was classified as failure.

Adolescent↗
PubMed2002

[Transcutaneous carbon dioxide and oxygen measurement in patients undergoing microlaryngosurgery with high frequency jet ventilation].

BACKGROUND: High frequency jet ventilation (HFJV) via thin tracheal tube is a convenient method of ventilation in microlaryngosurgery, but the problem of the assessment of oxygen and carbon dioxide status during HFJV is yet to be studied. METHODS: Fifteen patients undergoing microlaryngosurgery under total intravenous anesthesia with HFJV were studied. The combined transcutaneous carbon dioxide (PtcCO2) and oxygen (PtcO2) levels were compared with arterial blood gas values (PaCO2, PaO2). RESULTS: The PtcCO2 values demonstrated a high degree of correlation with PaCO2 before intubation (r = 0.97), during HFJV (r = 0.96), and after anesthesia (r = 0.93). The PaO2 values demonstrated a generally good correlation with PaO2 before intubation (r = 0.78) and during HFJV (r = 0.83), but not after anesthesia (r = 0.54). CONCLUSION: Capnography values are invalid during HFJV, and an arterial catheter is not always indicated and feasible in microlaryngoscopy. The transcutaneous devices provide an effective method for non-invasive monitoring of PaCO2 in situations where continuous and precise control of CO2 levels is desired such as in perioperative period of microlaryngosurgery with HFJV.

Adult↗
PubMed1976

[Study of pressure and FeCO2 during ventilation by injection (preliminary note)].

This study, carried out in nine patients, attempted to judge the efficacy and possible inocuity of ventilation by injection (jet ventilation), firstly on capnography and. secondly, on recordings of intra-tracheal pressure. The frequency of six jets per minute, is that which, under the conditions of the trial, ensures the best removal of CO2 and the maintenance of stable CO2 levels in the trachea. Although pressures recorded in the airways varied between 15 and 40 torrs, the finding of very high peaks of pressure in certain cases, makes the authors somewhat reserved concerning the security of the method when the free reflux of gas is liable to be inhibited.

Bronchoscopy↗
PubMed1992

Relationships between some oxygen and carbon dioxide indices in patients with chronic lung and cardiovascular diseases.

A total of 281 patients were divided into groups according to their clinical diagnosis and were examined using capnography, spirometry and blood-gas analysis. The highest percentage of patients with arterial hypoxemia was found in the group with chronic bronchitis and emphysema. The same group had the highest number of patients with moderate hypoxemia and was the only group containing patients with severe hypoxemia. Alveolar hypoventilation and increased ventilation-perfusion ratio were most pronounced in patients with chronic bronchitis and emphysema. The greatest negative correlation between PaO2 and PaCO2 was found, again, in this group. We also found the greatest direct correlation between the oxygen and carbon dioxide gradients in this group. These results suggest that the relationships between the partial pressures of O2 and CO2 depend on the type of the pulmonary and cardiovascular diseases. The relationships between the partial pressures of O2 and CO2 as well as between their gradients, become stronger with the increase of the ventilation-perfusion ratio. The relationships between the expired alveolar gases are approximately the same as those of these gases in blood.

Adult↗
PubMedDate not supplied

[Comparative analysis of the criteria for surveillance and monitoring in anesthesia, resuscitation and pain therapy. Recommendation of the Sociedad Española de Anestesia y Reanimación].

INTRODUCTION: One part of morbidity and mortality associated with anesthesia is due to accidents. It is thought that an additional monitoring can prevent and avoid most of anesthetic accidents. OBJECTIVES: In order to improve patient's safety and quality of anesthesia, Harvard University hospital approved in 1985 the rules for intraoperative monitoring. These were adopted by the American Society of Anesthesiologists (ASA) in 1986. In line with this procedure, professional associations of several countries pronounced their own rules. SEDAR did it in 1989. The purpose of this study was to compare spanish rules with those of America (Harvard and ASA), Australia, England and France. RESULTS: Comparative analysis revealed that the spanish norms are more extensive since they include not only the intraoperative anesthetic activities, but also those related to recovery, pain, and obstetric anesthesia. However, it has some deficiencies such as the lack of a periodical revision, and of an adaptative period and assistance to the anesthesiologist provided by auxiliary personnel. Successful points were the recognition that pulse oximetry is essential, the preoperative verification of all material, and, more importantly, is the only one that considers essential capnography in the assessment of ventilation and pulse oximetry during regional anesthesia and postoperative phase. CONCLUSION: Spanish norm is comparable to that of the other countries considered in this study. It shows important successful points and at the same time some significant deficiencies.

Analgesia↗
PubMed1976

[Neuroleptics and continuous measurement of intracranial pressure].

Neurosurgical patients, whether injured or not, have benefited in recent years from a new technique of supervision, measurement of thr intracranial pressure (ICP). Thus, measurement of a pressure figure and its course, gives precious information, both diagnostic and therapeutic. Various techniques of measurement are now proposed. We chose, for special reasons, measurement of the ICP within the ventricle. A catheter is introduced into the ventricle through a trephine hole. It is linked by a liquid column to a recording system (cathode oscilloscope, ink writer or magnetic tape). A slow inscriber permits continuous recording of the ICP for several days or even weeks. In view of the narrow dependency of the ICP on other physiological parameters, it seemed to us essential to record simultaneously 5 other parameters, the temperature, the blood pressure, the central venous pressure, the heart rate and the respiratory ventilation, by measurement of FeCO2 (capnography). Several forms of treatment have been proposed to bring down a raised ICP (greater than 15 mm Hg), e.g. osmotic diuresis, hyperventilation, corticosteroid therapy. Removal of CSF by ventriculalar catheter, sometimes permits one to pass over the critical period. It was in this background that we attempted to analyse the effect of neuroleptics on the ICP, without attempting to explain their mechanism of action. Our study was of 10 patients with cranial trauma, of both sexes, aged from 14 to 60 years. The intracranial pressure was measured within the ventricle and correlated with the other physiological parameters. When the ICP was normal, e.g. primary lesion of the brain stem, administration of neuroleptics such as chlorpromazine 100 mg IV/24 hours, or levopromazine 50 mg IV/24 hours, does not modify the value of the ICP. On the other hand, in the case of raised intracranial pressure due to contusion with cerebral oedema, for example, the administration of neuroleptic drugs seems to provide a very slight reduction in this pressure. It would be interesting to measure, at the same time as the ICP, the cerebral blood flow.

Adolescent↗
PubMed2003

[Controversies in the treatment of shock].

In last years there are still dilemmas about the starting of prompt resuscitation by volume restoring in haemorrhagic shock in penetrant, non-penetrant and vascular injuries. Will massive fluid administration before surgical control of bleeding, because of destroying the primary thromb, induce excessive bleeding and worse outcome, in regard to postponed resuscitation until the control of haemorrhage? What means that less fluid should be given, less than optimal, but in the quantity with which progressive circulatory shock will be avoided. According to some authors this should be followed in the treatment of non-penetrant injuries, what has been shown positive in animal models. There is also dilemma about the kind of fluid, crystalloids and what crystalloids, or colloids? Crystalloids are preferred, especially to Ringer lactat, except in the cases of traumatic brain injury when saline is better, because of mild hyperosmolarity. Hypertonic solutions 7.5% NaCl and 3% NaCl have advantages for prehospital resuscitation. As the advantages of colloids in regard to crystalloids were not proven, they should be used together with crystalloids, if the blood products are not available at the moment, and they should be given. It is considered that about 25% of overall colloid used is not justified. In the assessment of shock, i.e. tissue perfusion which is the most important parameter of shock, modern technologies measure systemic oxygenation SO2 as a balance of oxygen delivery DO2 and oxygen consumption DO2 and mixed venous blood PCO2. Noninvasive monitoring replaces invasive, and it can be even more precise and more accurate in parameter assessment. Sublingual capnography is new monitoring as indirect indicator of gut mucose perfusion and impedance monitoring which functions by means of measuring the changes of electrical impedance of thorax which are proportional to the pulse wave in aorta during systole and diastole.

Animals↗
PubMed1992

[Intraoperative complications during cementation of hip arthroplasty. Avoiding air embolization during cementation].

Circulatory collapse is known to occur during cementation of hip arthroplasty. The pathogenesis is multifarious, but the most important cause is believed to be formation of air embolism during insertion and cementation of the femoral component followed by air embolism in the heart. Inserting the cement retrogradely with a cement gun following distal plugging of the femoral cavity with spongiosa and using a plastic catheter for suction drainage reduces the air embolisation. Cement producing as little heat as possible during the setting should be used. Maintaining anaesthesia with N2O air embolism and should be avoided during and after cementation. Pre- and intraoperative care of the patient's circulation and oxygenation is essential. The use of pulse oximetry, capnography and precordially recorded Doppler ultrasound are recommended for monitoring air embolism.

Anesthesia, Inhalation↗
PubMed1992

Respiratory gas monitoring in the pediatric patient.

Parents of soon-to-be-anesthetized children frequently express concern about their child's safety because they have heard that "anesthesia is the most dangerous part of the operation." Although I don't believe that statement was ever true, it is even less true today. With the development of reliable capnography and volatile agent measurement in infants and children, we have significantly reduced the risks associated with anesthesia. I think we can, and should, confidently reassure parents that the "anesthesia part of the operation" has been made much safer and that the child's breathing (as well as heart beat, temperature, oxygenation, etc.) will be vigilantly monitored by the anesthesiologist using both human senses and the latest in monitoring equipment.

Carbon Dioxide↗
PubMed2004

[Respiratory and hemodynamic monitoring during laparoscopy and two computer-controlled TCI anesthesiologic technique].

Forty women under general anaesthesia (computer-controlled TCI-infusion) in two groups were subjected to non-invasive haemodynamic monitoring together with arterial gasometry and capnography. Simultaneous continuous monitoring of aortic blood flow and PetCO2 allows an undelayed recognition of major circulatory disturbances, before significant changes in heart rate and arterial pressure occur.

Anesthesia, Intravenous↗
PubMed2004

End-tidal CO2 for prediction of cardiac output following weaning from cardiopulmonary bypass.

This prospective study included 32 patients undergoing cardiopulmonary bypass (CPB) for elective coronary artery bypass grafting correlates the respiratory end-tidal CO2 (ETCO2) during partial separation from CPB with cardiac output (CO) following weaning from CPB. After induction of general anesthesia, a pulmonary artery catheter was inserted for measurement of cardiac output by thermodilution. Patients were monitored using a 5-lead ECG, pulse oximeter, invasive blood pressure monitoring, rectal temperature probe, and end-tidal capnography. At the end of surgery, patients were weaned from CPB in a stepwise fashion. Respiratory ETCO2 and in-line venous oximetry were continuously monitored during weaning. The ETCO2 was recorded at quarter pump flow and after complete weaning from CPB. Following weaning from CPB, CO was measured by thermodilution. The CO values were correlated with the ETCO2 during partial bypass and following weaning from bypass. Regression analysis of ETCO2 at quarter-flow and post-bypass CO showed significant correlation (r = 0.57, p < .001). Also, regression analysis of ETCO2 after complete weaning from bypass and post-bypass CO showed significant correlation (r = 0.6, p = .002). The correlation between ETCO2 and CO showed that an ETCO2 >30 mm Hg during partial CPB will always predict an adequate CO following weaning from CPB. An ETCO2 <30 mm Hg may denote either a low or a normal cardiac output and hence other predictive parameters such as SvO2 must be added.

Aged↗
PubMedDate not supplied

[Complications of accelerated opioid detoxification].

All accelerated opioid detoxifications under anesthesia, which were performed at our district hospital during 3 years (1999 to 2002), have been retrospectively analyzed. A total of 48 detoxifications were made in 43 patients. Three serious complications were recorded. In the first case, there was incomplete detoxification using naltrexone. The naloxone test was negative. After recovery from anesthesia, the patient developed a severe withdrawal syndrome that required repeated detoxification. In the second case, the patient developed bedsores at the site of the sacrum and scapulae after 7-hour detoxification. Reddening and edema disappeared on day 3 without treatment. In the third case, there was insufficient artificial ventilation due to inspiratory valvular defect. Capnography was not applied. The symptoms of hypercapnia, such hypertension, hyperemia, sweating, were regarded as the symptoms of abstinence so anesthesia was intensified. Valvular defect was detected when the patient developed hypoxia. All the patients were discharged from hospital in a satisfactory condition.

Adult↗
PubMed2005

Anesthetic implications of laparoscopic adrenalectomy in nephrotic syndrome.

UNLABELLED: During the last two decades laparoscopic surgery has become a widely practiced procedure. Laparoscopic adrenalectomy for adrenal tumor excision is one of these new applications. The anesthesia implication are special in the presence of long standing essential hypertension and nephrotic syndrome with poly-pharmacy. OBJECTIVES: To report on the first anesthesia for laparoscopic adrenalectomy Security Forces Hospital (SFH) in Riyadh. SETTING: Tertiary care SFH in Riyadh. PATIENT: A 58 year old Saudi woman diagnosed to have essential hypertension, nephrotic syndrome, NIDDM, and right adrenal tumor, with the provisional diagnosis of pheochromocytoma. INTERVENTIONS: General anesthesia, Thoracic epidural, control of hypertension with both alpha and beta blockers, and selective SICU admission for monitoring and pain relief. MEASUREMENT AND THE MAIN RESULTS: Preoperative ultrasound and MRI, MIBG scan of the adrenals, catecholamines serum level, intraoperative direct cardiovascular pressure measurements using Swan-Ganz catheter and arterial line. Pain control using epidural narcotics, measurement of blood glucose, blood gases, urea, creatinine and electrolytes. Adequacy of ventilation monitored by capnography and pulse oximetry. The surgical procedure included right adrenalectomy and cholecystectomy. CONCLUSION: Anesthesia for laparoscopic adrenalectomy has special problems to solve related to the pneumoperitonium effect, poly-pharmacy and the current disease state. The use of modern anesthetic agents, cardiovascular monitoring, ventilation and proper analgesia make the hospital stay short, morbidity and mortality minimal.

Adrenal Glands↗
PubMed2006

Mechanisms underlying gas exchange alterations in an experimental model of pulmonary embolism.

The aim of the present study was to determine the ventilation/perfusion ratio that contributes to hypoxemia in pulmonary embolism by analyzing blood gases and volumetric capnography in a model of experimental acute pulmonary embolism. Pulmonary embolization with autologous blood clots was induced in seven pigs weighing 24.00 +/- 0.6 kg, anesthetized and mechanically ventilated. Significant changes occurred from baseline to 20 min after embolization, such as reduction in oxygen partial pressures in arterial blood (from 87.71 +/- 8.64 to 39.14 +/- 6.77 mmHg) and alveolar air (from 92.97 +/- 2.14 to 63.91 +/- 8.27 mmHg). The effective alveolar ventilation exhibited a significant reduction (from 199.62 +/- 42.01 to 84.34 +/- 44.13) consistent with the fall in alveolar gas volume that effectively participated in gas exchange. The relation between the alveolar ventilation that effectively participated in gas exchange and cardiac output (V Aeff/Q ratio) also presented a significant reduction after embolization (from 0.96 +/- 0.34 to 0.33 +/- 0.17 fraction). The carbon dioxide partial pressure increased significantly in arterial blood (from 37.51 +/- 1.71 to 60.76 +/- 6.62 mmHg), but decreased significantly in exhaled air at the end of the respiratory cycle (from 35.57 +/- 1.22 to 23.15 +/- 8.24 mmHg). Exhaled air at the end of the respiratory cycle returned to baseline values 40 min after embolism. The arterial to alveolar carbon dioxide gradient increased significantly (from 1.94 +/- 1.36 to 37.61 +/- 12.79 mmHg), as also did the calculated alveolar (from 56.38 +/- 22.47 to 178.09 +/- 37.46 mL) and physiological (from 0.37 +/- 0.05 to 0.75 +/- 0.10 fraction) dead spaces. Based on our data, we conclude that the severe arterial hypoxemia observed in this experimental model may be attributed to the reduction of the V Aeff/Q ratio. We were also able to demonstrate that V Aeff/Q progressively improves after embolization, a fact attributed to the alveolar ventilation redistribution induced by hypocapnic bronchoconstriction.

Acute Disease↗
PubMed1991

[Goals and methods of patient monitoring].

Monitoring during and after anaesthesia is aimed at recording changes in physiological functions including the patient's response to the anaesthetic and surgery, and identifying avoidable critical incidents caused by human error or equipment failure. Assessment and control of the depth of anaesthesia would be desirable but cannot yet be accomplished in clinical practice. For every anaesthetic, some degree of primary, basic or minimal monitoring is essential and is, in a number of countries, prescribed or recommended by regulations or guidelines. Besides an alert anaesthetist constantly observing the patient and monitoring the function of the anaesthesia machine, these minimal standards include an ECG, noninvasive blood pressure measurement, pulse oximetry, and end-tidal CO2 recording (capnography). ECG, blood pressure, and pulse oximetry also have to be employed during regional anaesthesia and in the post-anaesthesia care unit. The question as to whether further monitoring techniques need to be added (extended or secondary monitoring) will depend upon the medical problems of the individual patient and on the nature and duration of the surgical and anaesthetic procedures. For this purpose, invasive methods are preferentially used, in particular central venous and arterial pressure recording, and a pulmonary artery catheter for measuring pulmonary artery and pulmonary capillary wedge pressures and cardiac output, all in combination with blood gas analysis.

Anesthesia↗
PubMed1991

Noninvasive respiratory monitoring during ventilatory support.

Noninvasive monitoring is commonly used during ventilatory support. This monitoring includes pulse oximetry, capnography, transcutaneous monitoring, monitoring of respiratory mechanics, and indirect calorimetry. There are advantages and disadvantages to each of these forms of monitoring and the technical ability to use each of them must be balanced against clinical usefulness.

Blood Gas Monitoring, Transcutaneous↗
PubMed1991

The art and science of mechanical ventilator adjustments.

This article describes how information from mechanical ventilator settings, ABG, pulse oximetry, and capnography are useful in making therapeutic changes in mechanical ventilator settings. The nurse can use trial and error or apply scientific principles to adjust mechanical ventilator settings efficiently to correct abnormalities in ventilation or oxygenation. Consistent application of these principles improves nursing assessment and interventions as well as prevents undue pain and expense on the patient's behalf.

Blood Gas Analysis↗
PubMed1991

[Clinical evaluation of arterial tonometry for noninvasive, continuous blood pressure monitoring during anesthesia].

A new continuous, non-invasive arterial blood pressure monitoring system based on arterial tonometry was currently developed. A sensor of this system consists of an array of 15 piezoresistive pressure transducers. An automatic sensor positioning system ensure that at least one of the 15 transducers is positioned on the center of the pneumatically flattened, but not occluded, portion of the artery. Accuracy, reliability and clinical acceptance of this system were evaluated by comparing tonometric blood pressure (TBP) measurements with intra-arterial blood pressure (IBP) measurements in 70 normotensive anesthetized patients (normotensive group) and 21 hypotensive anesthetized patients (hypotensive group). IBP was measured in either the right or left radial artery by a Gould P23XL calibrated transducer while TBP was measured at the radial artery of the other side. The outputs of the two systems were recorded on a PCM tape recorder for later analysis. The TBP waveform was similar to the IBP waveform. A significantly high correlation existed between the two methods for systolic, mean and diastolic measurements. Magnitudes of bias (mean difference between the two methods) of the normotensive group were -0.4 +/- 5.9 (mean +/- SD) mmHg for systolic, -0.1 +/- 4.7 mmHg for mean and 0.0 +/- 5.4 mmHg for diastolic measurements and those of the hypotensive group were -0.7 +/- 6.6 mmHg for systolic, 0.7 +/- 5.0 mmHg for mean and 2.8 +/- 5.8 mmHg for diastolic measurements. The "limits of agreement" (mean difference +/- 2SD of bias) for both groups were within the range which would be acceptable for clinical setting. These results indicate that tonometry provides accurate, reliable and real-time blood pressure measurements together with continuous display of the pressure waveform for wide range of blood pressure. It was concluded that this system may replace the conventional invasive intra-arterial blood pressure monitoring system. This system is especially useful if it is combined with pulse oximetry and capnography.

Adolescent↗