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At least 667 records · Page 37Linked to original sources
PubMed1980

[Treatment of isolated postoperative respiratory complications by constant positive pressure in spontaneous ventilation].

Positive pressure at the end of expiration (PEEP) applied in spontaneous ventilation (CPAP) has the same ventilatory effects as in controlled ventilation without the harmful actions. Few studies have described the use of CPAP in severe isolated postoperative respiratory insufficiency. CPAP was applied in 16 patients free of chronic bronchopulmonary disease, aged between 22 and 82 years, and suffering after major thoracic and/or abdominal surgery from isolated acute respiratory insufficiency as defined by clinical, blood gas and rediological criteria. CPAP was applied with mask alone (n = 5) or by nasotracheal intubation followed by mask (n = 11). PEEP was regulated at +1.7 to +2.94 KPa (+ 12 to 30 cm H2O) in order to obtain a PaO2/FIO2 greater than or equal to 300. Alveolar ventilation was assessed by capnography. Improvement was marked in six days : the PaO2/FIO2 ratio at nil PEEP fell from 129 +/- 3.2 to 3.73 +/- 6.5 (mean +/- SD), the score of interstitial and alveolar opacities from 25 to 4 and the atelectasis score from 10 to 1. These results show the efficacy of CPAP in the early treatment of isolated postoperative acute respiratory insufficiency.

Humans↗
PubMed1977

[Impairments of co2-gas-exchange during the provocative inhalation in children with bronchial asthma (author's transl)].

Report on the investigation of CO2-Gas-exchange during provocative inhalation tests in children suffering from bronchial asthma. An increased difference in CO2-gradients by increase of PVCO2 and decrease of PACO2 was found. The values of Pco2a are unchanged. The capnography seems to be useful in continious monitoring of obstructive ventilation disorders during provocative inhalation tests, especially in children.

Asthma↗
PubMed1984

[Anesthesia in dystrophia myotonica using the capnogram].

The dangers associated with anaesthesia and postoperative care in patients with dystrophia myotonica are reviewed. Weakness, atrophy and myotonia of the respiratory muscles and abnormal drug responses are among the many features of the disease which create specific problems. Capnography is obviously a monitor of particular value, yet capnograms in dystrophia myotonia patients have never been published. Abnormal capnograms recorded in a patient with dystrophia myotonica before and after the administration of neostigmine are described. A technique of anaesthetic management avoiding drug liable to produce abnormal reactions, and with the capnogram as a guide, is discussed.

Adolescent↗
PubMed1978

[Respiratory arrest during sleep. Facts and hypothyses].

The writers analyze 29 nyctohemeral recordings in 20 patients with sleep apneas. In addition to the standard polygraphy, use is made of pneumotachography and capnography. The results (central apnea with open or secondarily closed glottis; obstructive apnea with closed glottis or with expiratory valve phenomenon) raise the hypothesis of a central physiopathological mechanism common to the various types of apneas through a more or less dissociated inhibition of the activity of the respiratory, laryngeal, intercostal, and diaphragmatic muscles:--in central apnea: inhibition of the thoracoabdominal activity and maintenance of the tonicity of the laryngeal muscles, keeping the glottis open;--in obstructive apnea: persistence of the thoracic and/or abdominal activity with inhibition of the activity of the laryngeal muscles, leading to a passive obstruction due to the effect of inspiratory depression.

Airway Obstruction↗
PubMed1982

Metabolic changes after tourniquet release.

During routine capnography a rise of the end expiratory volume percentage CO2 was seen after releasing the tourniquet cuff in cases of orthopedic operations on the lower extremities under bloodless conditions. The patients were intubated and ventilated mechanically. In eight patients the relationship between this finding and the arterial bloodgas values were studied at one minute before and at one, ten and thirty minutes after releasing the tourniquet cuff. The end expiratory volume percentage CO2 increased from 4.21 +/- 0.22 to 4.83 +/- 0.26 one minute after releasing tourniquetischemia and even to 5.49 +/- 0.68 after three minutes. PaCO2 increased in one minute from 4.83 +/- 0.49 to 6.22 +/- 0.50 kPa (36.2 +/- 3.7 to 46.6 +/- 3.7 mm Hg). The pH, st. HCO-3 and base excess decreased in one minute from resp. 7.45 +/- 0.04, 27.16 +/- 1.04 mmol/l (mEq/l) and + 2.85 +/- 1.29 mmol/l (mEq/l) to 7.34 +/- 0.04, 24.75 +/- 1.16 mmol/l (mEq/l) and - 0.18 +/- 1.49 mmol/l (mEq/l). The capnographic values seems to reflect bloodgas changes. The findings were compared with recent literature.

Adolescent↗
PubMed1978

The importance of monitoring in anesthesia.

A plea is made for continuous electronic monitoring of every patient undergoing an anesthetic. Such monitoring is far superior to clinical observation by means of the natural sensors. A continuous record of the vital phenomena is indispensable. Routine monitoring of the following is advised: ECG, heart rate, capnogram, plethysmogram, temperature, oxygen percentage and indirect blood pressure. Big operations demand central venous pressure and direct blood pressure monitoring, in addition. In the Institute of Anesthesiology in Utrecht all electronic monitors are built into a single unit which is used during every anesthetic. Capnography it dealt with in some detail and its value as a universal monitor demonstrated. The routine use of electronic monitors improves the quality of anesthesia and increases the safety of the patient.

Adolescent↗
PubMed1978

[Air embolism; a complication during neurosurgery in the sitting position (author's transl)].

Neurosurgery in the sitting position not only puts a strain on the cardiopulmonary system, but also carries the risk of venous air embolism. Special monitoring procedures as well as prophylactic measures greatly contribute towards the safety of the patient. The pathogenesis, pathophysiology and the symptoms of venous air embolism are reviewed, and various monitoring methods are discussed, with special reference to their reliability, sensitivity and practicability. The analysis shows that the Doppler ultrasound method, continuous capnography during the duration of the operation, intra-arterial measurement of blood pressure, recording of the central venous pressure and of electrocardiographic changes are essential means of routine monitoring. Suspected air embolism must be promptly dealt with not only by ligation of the severed vein but also by attempts at aspiration of the air bubbles via the atrial catheter. The latter, therefore, plays an important role both as a diagnostic parameter and a therapeutic agent. Although the suggested prophylactic measures do not absolutely protect against complications they will markedly reduce the incidence of venous air embolism.

Blood Pressure↗
PubMed1981

[Diagnosis and functional assessment of pulmonary thromboembolism].

The authors discuss the problems of diagnostics and functional assessment of pulmonary thrombo-embolia. The potentialities of the clinical indices, electrocardiography, X-ray, blood-gas analysis, capnography, right cardiac catheterization and angiopulmography in the diagnostics and assessment of the form of thrombo-embolia of pulmonary artery were revealed in 54 patients with cardiac and pulmonary form of thrombo-embolia. The stage potentialities in that respect of the various health institutions are outlined and the necessity of evacuation of the patients where they would be best attended is stressed upon.

Adult↗
PubMedDate not supplied

[Physiopathologic implications of the anesthesiologic management of pediatric laparoscopic surgery].

We study gas exchange and hemodynamic repercussions during pediatric laparoscopic surgery. We provided balanced anesthesia with muscle relaxation while ventilation was maintained with FiO2 at 0.4 and flow volume between 10-15 ml/kg-1 during abdominal laparoscopic procedures performed in 10 ASA I-II children (4-14 years). Pneumoperitoneum was produced with CO2 insufflated up to a pressure of 15 mmHg. Airways pressure (PIP), PaO2, PaCO2, heart rate (HR), systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were measured before insufflation and 5, 30 and 60 minutes afterwards. We calculated the ratio of dead space to flow volume (VD/VT), thoracic distensibility and metabolic production of CO2 (VCO2). Insufflation caused an immediate reduction (29-33%) in dynamic thoracic distensibility (p = 0.0004), but no hypoventilation or increases in VD/VT. The decrease in PaO2 was small (5-6%) but statistically significant (p = 0.0188). Hypercapnia (14-21%) was due to an increase in VCO2 caused by gradual peritoneal absorption of CO2 (24-32%, p = 0.0013). We also found increases in SAP (10%, p = 0.02) and DAP (32%, p = 0.0001) at 5 min, along with an increase in HR (8%, p = 0.0163) at 60 min. Arterial CO2 levels were held within physiological limits by compensatory hyperventilation (+25% of physiological VT). Capnography proved to be an excellent guide. Any clinical repercussion of hemodynamic effects was blocked by a dose of atropine given before insufflation and by the excess loading volume (10 ml/kg of crystalloids). Laparascopic surgery in children diminishes thoracic distensibility and causes hypercapnia, making it necessary to measure PefCO2 to regulate ventilation.

Adolescent↗
PubMedDate not supplied

[Prolonged neuromuscular block caused by succinylcholine in a patient with normal cholinesterase activity].

The authors describe a case of prolonged neuromuscular blockade following suxamethonlum in a patient with a normal cholinesterase activity and dibucaine number > or = 75%. In this case a peripheral nerve stimulator and capnography allowed neuromuscular blockade evaluation and fresh frozen plasma infusion led to a normal recovery from suxamethonium neuromuscular blockade. This report suggests a case of abnormal cholinesterase activity described as "silent variant".

Adult↗
PubMed1995

[Transient tracheal obstruction during surgical correction of scoliosis in a patient with Marfan's syndrome].

A 13-yr-old male with Marfan's syndrome underwent surgical correction of severe scoliosis. He had not manifested dyspnea previously in any position. Under anesthesia with thiamylal and vecuronium, his trachea was intubated with a reinforced endotracheal tube without any difficulty. Anesthesia was maintained with nitrous oxide and fentanyl, 8 micrograms.kg-1. The patient was placed in a prone position. Thirty min after the start of operation, when orthopedists compressed the thoracic vertebrae vertically, positive pressure ventilation became impossible abruptly, even with a high airway pressure. Three min later, ventilation became possible after cessation of compression and by mouth-to-tube insufflation. SpO2 monitored with a pulse oximeter recovered immediately from 61% to 99%. A capnogram showed a lengthy retardation of an inspiratory phase. Emergency fibreoptic bronchoscopy revealed that the trachea had been compressed vertically; the compression was reduced by moving the chest supporters laterally. After the apneic episode, the operation continued uneventfully, and he was discharged a month later. A severe deformity of the thorax due to severe scoliosis and weak tracheal tissue due to connective tissue defect caused partial tracheal compression before the surgery, and made his trachea susceptible to complete obstruction by vertical external compression on the thorax. Patients with Marfan's syndrome and scoliosis should have careful preoperative airway evaluation. The selection and positioning of endotracheal tubes should be done with care. During surgery, the patient's body position and the condition of the trachea should be checked frequently. Capnography and fiberoptic bronchoscopy seem to be mandatory for early detection of tracheal stenosis and prevention of tracheal obstruction.

Adolescent↗
PubMed1995

Biosensors and bioprobes in anaesthesia and intensive care. From in vitro to in vivo monitoring.

In vitro monitoring is inherently invasive with discrete measurements on blood samples and the results are often delayed an hour or more when the analyses are performed in the central laboratory. The delay may be greatly reduced if the analyses are performed near the patient. In vivo monitoring may be non-invasive and may provide continuous real-time data but the accuracy usually does not match that of in vitro measurements. In vivo monitoring therefore finds its application in the detection of trends of change, and it is needed only for quantities that change rapidly and unpredictably and where a suitable therapeutic action is available. In critically ill patients, this applies to the arterial pO2, pCO2, and pH, and the mixed venous pO2. Ideal in vivo monitoring techniques are not available for all these quantities. In the newborn, the arterial pO2 may be monitored with a transcutaneous pO2 electrode. In the adult, the arterial pO2 may be monitored indirectly by monitoring the arterial oxygen saturation with a pulse oximeter and the mixed venous pO2 by monitoring the mixed venous oxygen saturation with a catheter tip sensor. The arterial pCO2 may be monitored with a transcutaneous pCO2 electrode or by capnography, i.e., by monitoring the end-expiratory pCO2. Other in vivo monitoring techniques such as gastric tonometry for the gastric mucosal pH and thoracic impedance measurement have found some routine application, whereas near-infrared spectrometry for oxy- and deoxyhaemoglobin in the brain, and magnetic resonance spectroscopy for tissue ATP are at the stage of research and development.

Adult↗
PubMed1995

Hypercarbia induced by detachment of inner fresh gas delivery tube of the bain circuit--a case report.

Semi-open system such as Bain circuit is occasionally used in general anesthesia. The system has many advantages such as use of a single, light weight tube which is adaptable to both adult and pediatric patients and bypass of the carbon dioxide absorber. It is especially useful in procedures on the head, face and neck. The main disadvantage of Bain circuit is the difficulty in testing the inner tube. We encountered a case of hypercarbia due to detachment of the inner fresh gas delivery tube of the Bain circuit. The whole outer tube became a dead space and as a consequence, hypercapnia was unavoidable due to the "to and fro" mechanism of rebreathing. Adequate gas flow and manual hyperventilation would not correct the situation. After changing the tube CO2 tension gradually returned to normal. Many methods for testing of the Bain circuit have been published. Pethick technique, Foëx and Crampton Smith test and test adaptor are useful. Hypercarbia is difficult to detect under general anesthesia. It is often misdiagnosed due to its similarity to other stress responses. Therefore, it is necessary to check ABG's in patients with unexplained tachycardia and/or in those who fight the ventilator even with sufficient amount of muscle relaxant. For quality assurance, use of capnography is recommended for routine use in anesthesia.

Anesthesia, General↗
PubMed1994

[Have anesthesia-related mortality and morbidity decreased in the last 30 years? Evaluation based on a review of epidemiologic studies].

The objectives of this lecture are to review the various studies of anaesthetic outcome in order to answer some questions of importance for the clinical practitioner: 1) does anaesthesia contribute to operative mortality and, if yes, to what extent?; 2) has anaesthetic mortality decreased in the last 30 years?; 3) has the risk of major morbidity from anaesthesia been reduced in the past decades?; 4) what are the causes of adverse outcome in anaesthetic practice? The contribution of anaesthesia to perioperative mortality varies from 5 to 15 per cent out of operative deaths according to the data reported in the surveys published during the last decade. The comparison of the data from successive studies in the same country using comparable methodology leads to believe that anaesthetic mortality has decreased in the last 30 years. Similarly, the risk of major morbidity from anaesthesia such as cardiac arrest appears to be reduced when the rate of this complication is compared between two periods. The most preventable causes of adverse anaesthetic outcome are respiratory damaging events. The main causes are inadequate ventilation and/or oxygenation and problems related to tracheal intubation. Most of these cases could have been prevented by a faster detection with the combination of pulse oximetry and capnography.

Anesthetics↗
PubMed1995

[Monitoring of bone marrow spilling and cardiopulmonary changes in fat embolism syndrome].

After long bone fractures, as well as hip or knee total arthroplasty, the increase in intramedullary pressure induces bone marrow release into the circulation in more than 90% of patients. Three to four percent of the patients reveal fat embolism syndrome with pulmonary and cerebral involvement and a petechial rash. In about 20% of these patients a fulminant and fatal course is possible. Although fat embolism syndrome was described more than a century ago, there is still no sufficient therapeutic strategy. Because of these facts we try to prevent fat embolism syndrome and monitor patients at risk perioperatively. We have evaluated different diagnostic methods and monitoring facilities and recommend pulse oximetry, capnography, ECG, blood pressure controls and, if indicated, blood gas analyses for perioperative monitoring. Patients at risk and patients who are suffering from fat embolism syndrome require more intensive monitoring, such as transesophageal echocardiography and a pulmonary artery catheter to obtain more detailed information about the hemodynamic and oximetric variables. Furthermore, these patients must be admitted to an intensive care unit.

Blood Gas Analysis↗
PubMed1994

[Effect of intravenous ambroxol hydrochloride on lung function and exercise capacity in patients with severe chronic obstructive pulmonary disease].

The effect of Ambroxol hydrochloride on spirometry, pulmonary gas exchange and exercise capacity in patients with COPD were evaluated. Twenty patients mean age 59 +/- 9 yr presenting with severe airways obstruction were divided by random number to two groups: treated (L) and control (K). L patients received iv infusion of one gram of Ambroxol in 500 ml of 0.9% saline daily, for 5 days. K patients received infusions of 500 ml 0.9% saline at the same intervals. Blood gases, capnography and incremental exercise test on cycloergometer were performed before treatment and after the fifth dose of the drug or placebo. Before treatment spirometry, blood gases, capnometric++ indices and exercise tolerance were similar in both groups. After treatment in patients from L group an increase in VC from 1.78 +/- 0.61 L to 2.04 +/- 0.58 L (p < 0.01), FEV1 from 0.96 +/- 0.43 L to 1.11 +/- 0.49 L (p < 0.01), MEF25 from 1.36 +/- 0.93 L/sec to 1.61 +/- 0.96 L/sec (p < 0.01) was found. End-tidal carbon dioxide in 60 sec hyperventilation test decreased from 3.7% to 2.9% (p < 0.001). There were no differences in exercise tolerance and blood gases after treatment. In the control group all studied variables remained unchanged. We conclude that Ambroxol improves airways patency in patients with severe COPD.

Aged↗
PubMed1994

Differences in end-tidal carbon dioxide and breathing patterns in ventilator-dependent patients using pressure support ventilation.

BACKGROUND: Although several investigators have assessed the effects of pressure support ventilation on tidal volume and breathing patterns, none have investigated the combination of breathing patterns and end-tidal carbon dioxide in ventilator-dependent patients. OBJECTIVES: To determine the differences in end-tidal carbon dioxide and breathing patterns at varying pressure support ventilation levels in ventilator-dependent patients. METHODS: Breathing patterns were measured with a plethysmograph and a ventilator. End-tidal carbon dioxide was measured by connecting the capnography sampler to the exhalation port of intubated patients. All equipment was connected to a five-channel recorder for data collection. The respiratory rate, tidal volume, minute ventilation, end-tidal carbon dioxide concentration, and chest and abdominal movement were recorded at 10-minute intervals at four pressure support ventilation levels (0, 10, 15, and 20 cm H2O). RESULTS: As pressure support ventilation increased, the respiratory rate, end-tidal carbon dioxide concentration, and asynchronous movement of chest and abdomen decreased. Tidal volume increased with higher pressure support ventilation levels. CONCLUSIONS: Pressure support ventilation prevents asynchronous chest and abdominal movement and lowers the level of end-tidal carbon dioxide. Pressure support ventilation offers clinicians a way to lower the elevated carbon dioxide level that often occurs in critically ill patients. Increasing tidal volume and reducing the work of breathing by using pressure support ventilation may reduce diaphragm fatigue in ventilator-dependent patients.

Abdominal Muscles↗
PubMed1994

Monitoring the respiratory system of the mechanically ventilated patient.

Bedside monitoring of respiratory status is designed to measure specific parameters and alert the clinician when these parameters exceed the limits of a desired range. Parameters should include measures of respiratory mechanics, oxygenation, and ventilation. Monitoring is the only form of communication between the physician and a patient receiving neuromuscular blocking agents. Airway pressure tracing alone, or in conjunction with concurrent flow, measures respiratory system mechanics, resistance, compliance, and the work of breathing. Pulse oximetry reflects oxygenation, while mixed venous oximetry indicates the balance between oxygen supply and demand. Capnography is a noninvasive way of assessing ventilation. Taken as a whole, noninvasive monitoring provides useful information, reflecting trends in oxygenation, ventilation, and mechanics. This article reviews the concepts of noninvasive monitoring of critically ill patients. Emphasis is given to the patient receiving neuromuscular blocking agents.

Airway Resistance↗