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PubMed1994

Pulmonary complications of feeding tubes: a new technique of insertion and monitoring malposition.

OBJECTIVE: To confirm the value of a new technique that will ensure safe introduction of feeding tubes. DESIGN: Two case reports; an anatomical and physiologic description of deglutition; and a case study. SETTING: A level 2 regional referral centre. PATIENTS: Thirteen anesthetized adult patients and 7 awake subjects, comprising patients scheduled to undergo elective surgery, medical staff and health care volunteers. INTERVENTIONS: Airway sampling for carbon dioxide with capnography in 13 anesthetized adults with the tip of the feeding tube in the pharynx, in the esophagus and in the trachea, and airway sampling for carbon dioxide from the pharynx and esophagus in 7 awake subjects during introduction of the feeding tube. Fluoroscopic monitoring of the position of the tip of the feeding tube during introduction in two patients and two volunteers. MAIN OUTCOME MEASURES: Carbon dioxide levels at the tip of the feeding tube during introduction. RESULTS: In all patients, with the tube either in the trachea or pharynx, a normal capnogram was displayed. When the tube was introduced into the esophagus no capnogram curve was seen, indicating the absence of carbon dioxide. With the subject lying down during introduction, the weighted tube followed the posterior pharyngeal wall to the upper esophageal sphincter. CONCLUSION: Positioning of the patient lying down with the head flexed and capnographic measurement of carbon dioxide levels from the tip of the feeding tube during insertion is a safe, accurate and cost-effective method for the introduction of feeding tubes.

Aged↗
PubMed1994

Towards patient safety in anaesthesia.

The anaesthesia specialty has focused on the safety of the patient and examination of untoward outcomes. Serious injuries are now rare in medically advanced countries. Still, anaesthesia deaths and complications are important because the anaesthetic itself has no intended therapeutic effect. Safety is a never-ending battle that requires continued effort because many forces have the potential to diminish whatever progress is made. This paper describes the modern movement in anaesthesia patient safety--the reasons it started, the major foci and explanations for why anaesthesia seems now to be safer than at any time in history. The American legal system, critical incident studies, studies of malpractice claims and large-scale studies of anaesthesia outcomes played a role in increasing the awareness of the need to enhance anaesthesia safety. Many efforts are believed to have contributed to improvements in the safety of anaesthesia: improved training of anaesthesia clinicians, new pharmaceuticals, new technologies for monitoring (especially pulse oximetry and capnography), standards for monitoring and other aspects of anaesthesia care, safety enhancements in anaesthesia equipment and the implementation of quality assurance and risk management programmes. The creation of the Anesthesia Patient Safety Foundation in the United States and a similar organization in Australia have helped to bring about awareness of safety issues and to support study of patient safety. Ultimately, the motto of the Anesthesia Patient Safety Foundation should be the goal of all anaesthesia professionals: "That no patient shall be harmed by anaesthesia".

Anesthesia↗
PubMedDate not supplied

[Adenosine triphosphate in the peroperative management of hypertensive crises and heart rate disorders in the surgical treatment of pheochromocytoma].

OBJECTIVE: To assess the hypotensive and antiarrhythmic effect of adenosine triphosphate (ATP) and its impact on hypertensive crises and heart rhythm abnormalities resulting from surgery to remove pheochromocytoma. PATIENTS AND METHODS: A prospective study of 7 patients with pheocromocytoma who were scheduled for unilateral (4) or bilateral (3) suprarenalectomy prior to treatment with phenoxybenzamine and propranolol. The anesthetic procedure was the same for all patients, as was monitoring: ECG, digital pulse oximetry, capnography, direct recording of arterial pressure by a catheter in the left radial artery and a Swan-Ganz fiber optic catheter in the pulmonary artery to measure pulmonary pressures and mixed venous oxygen saturation. Minute volume was measured by thermodilution. Blood glucose levels and urine excreted through a catheter were recorded hourly during surgery. During surgery, when arterial pressure had risen 20% above baseline level, i.v. infusion of ATP 0.5 mg/kg/min was begun and adjusted up or down depending on patient response. Infusion was stopped when the suprarenal vein had been tied. Hemodynamic analysis was performed during 4 phases: 1) start of surgery; 2) during manipulation of the tumor; 3) after excision, and 4) after surgery. Hemodynamic and metabolic variables were recorded, as were ATP doses and requirements for vasopressors and antiarrhythmic drugs. RESULTS: We found the following changes between phase 1 and phase 2, coinciding with ATP infusion: systemic arterial pressure increased 22.2%, heart rate increased 28.04% (with no cardiac arrhythmia observed in any patient), pulmonary artery pressure rose 25.35%, pulmonary capillary pressure rose 22.17%, cardiac index rose 108% while systemic vascular resistance decreased 55.82% and pulmonary vascular resistance decreased 33.96%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1994

[Right-sided pneumothorax in laparoscopic cholecystectomy].

In a 28-year-old woman right-sided pneumothorax developed during a laparoscopic cholecystectomy. The authors believe that the pneumothorax was caused by in the inflow of carbon dioxide into the thoracic cavity without injury to the diaphragm. So far, only a few reports of this complication exist, but in the future it will probably occur more frequently, since the number of laparoscopic operations is increasing. The symptoms are alterations in capnography, subcutaneous emphysema and diminished respiratory sounds.

Acute Disease↗
PubMed1993

Controlled ventilation with the Bain co-axial system. A rationalisation of gender-related minute volume requirements and carbon dioxide replacement therapy.

The minute ventilation required to maintain either hypocapnia (FE'CO2 = 4.0 kPa, group A, n = 36) or normocapnia (FE'CO2 = 5.0 kPa, group B, n = 38) in 74 adult patients was determined for the Bain system with controlled ventilation at 10 breath.min-1 and fresh gas flow equal to minute ventilation. Males required a greater minute ventilation and fresh gas flow than females (p < 0.01) in each group (group A, males approximately 90 ml.min-1.kg-1, females approximately 80 ml.min-1.kg-1; group B, males approximately 75 ml.min-1.kg-1; females approximately 65 ml.min-1.kg-1). Where capnography is not available, it may be safer to ventilate patients' lungs using the minute volume and fresh gas flow requirements established in group A patients. The administration of 5% carbon dioxide in oxygen for 2 min safely re-established normocapnia and spontaneous respiration in hypocapnic patients when ventilated with the same minute volume, fresh gas flow and respiratory rate required during surgery. Only one patient required greater than 400 ml.min-1 of carbon dioxide to produce a 5% concentration. Maximum flow from the carbon dioxide flowmeter may be restricted to 400 ml.min-1 rather than the 500 ml.min-1 currently recommended.

Adolescent↗
PubMed1993

[Disconnections in the breathing system].

Modern anaesthesia is considered as relatively safe. Nevertheless, incidents happen which result in harm for the patient. Incidents which cause hypoxia are especially grave. One of the most frequent incidents in anaesthesia and intensive care is of this nature: disconnection in the ventilatory apparatus. DEFINITION. Unintentional separation--partial or complete--of two manually connected components in a ventilatory apparatus. INCIDENCE. About 5% of incidents during narcosis are likely to be caused by disconnections in the ventilatory apparatus. CAUSES. Axially directed force of as little as 15 N may cause disconnection. It may result from active or passive movements of the patient, high pressure in the apparatus or unintentional traction on the breathing hoses. Conically moulded couplings are mostly used for connections. The stability of these so-called taper fit connections is decisively determined by the effort and technique of the user when coupling the two components. On the other hand the use of unsuitable materials may lead to an inadequate connection. Another possibility is damage by mechanical, chemical or thermal influences. Additionally, differences from the standard specifications of the components may occur. MOST COMMON SITES. Disconnections are found predominantly (in around 70% of cases) at the connection between the tube connector and the adapter or Y-piece. This joint represents a weak point, especially during surgical treatment in the head and neck region, when it cannot be controlled and in most cases is not accessible by hand because it is covered. CONSEQUENCES. The consequences of disconnection depend on different factors: relaxation of the patient, depth of narcosis, duration and localization of the disconnection, constitution and current oxygenation of the patient. An undetected disconnection may lead to hypoxia within a few minutes and then to irreversible brain damage and finally death. Serious incidents have been decreased in number in recent years by the application of improved monitoring procedures. DETECTION. Measurements of airway pressure, minute volume and expiratory CO2 by capnography ensure rapid detection of disconnections using appropriate adjustments of alarm limits. A disconnection may not be detected by pulse oximetry before a latent period, i.e. after a significant decrease of the oxygenation saturation of the patient. PREVENTION. Standardized specifications exist for technical dimensions of connectors, but "reliability" of connectors has not yet been defined in terms of technical requirements. Disconnection is currently prevented by application of various mechanical methods and devices, not all of which fulfil the conditions required of an ideal system: (1) Simple and fast connection ("single-handed operation"); (2) connection independent of the torsional angle between the two parts; (3)safe connection which cannot be detached unintentionally; (4) 360 degrees torsion possible after connection; (5) tight connection; (6) fast and easy deliberate disconnection; (7) intentional disconnection possible independent of the torsional angle between the two parts; (8) compatibility with conventional systems; (9) user's comfort and convenience (when ventilating with mask, etc.) as good as with conventional systems. DISCONNECTION OR EXTUBATION? There is a heated debate on the theme "disconnection". Some authors suspect that the development of reliable locking connections could lead to an increased frequency of unwanted extubations. To prevent unwanted extubations with consequent harm to patients, some developers propose a mechanical fuse, i.e. a defined site of fracture with an additional adequate monitoring device for reliable detection of disconnections. CONCLUSIONS. There are many approaches to the "disconnection" problem. In principle the problem requires a fundamental decision for each connection in the breathing system: safe prevention of disconnection (lock connection) or reliable mechanical f

Equipment Failure↗
PubMed1993

[The resorption of carbon dioxide from the pneumoperitoneum in laparoscopic cholecystectomy].

Laparoscopic cholecystectomy is claimed to be a minimally invasive procedure, but uptake of carbon dioxide (CO2) from the pneumoperitoneum (CO2-PP) can cause clinically relevant hypercapnia. In this prospective study, CO2 resorption during laparoscopic cholecystectomy was investigated. METHODS. In 30 patients (ASA I and II) total intravenous anesthesia was performed with propofol and fentanyl. Controlled ventilation was started with a tidal volume of 10 ml/kg min, a respiratory rate of 10/min, and FiO2 = 0.4 using an Engström Erica ventilator. When end-tidal CO2 (PeCO2) rose to 42 mmHg the respiratory rate was increased. In addition to standard monitoring, intra-abdominal pressure (IAP) was measured. Minute volume (VI), CO2 elimination (VCO2), oxygen uptake (VO2), and the respiratory quotient (RQ) were registered by indirect calorimetry from the Erica Metabolic Monitor. The CO2 resorption (delta VCO2) was calculated from the equation: delta VCO2(Mi) = VCO2(Mi) RQ(M1)VO2(Mi). (i = 1; 2; ...;5) All values are medians (interquartile range) or ranges. All parameters were compared at five measuring points that are characteristic for laparoscopic cholecystectomy: M1 baseline, 30 min after induction of anaesthesia, M2 10 min after starting CO2 insufflation, M3 while mobilising the gallbladder from the liver bed, M4 while extracting the gallbladder from the abdominal cavity, and M5 10 min after desufflating the CO2-PP (spontaneous breathing). RESULTS. A typical pattern of VCO2 was observed (Fig. 1). Baseline VCO2 was 165 (145-180) ml/min, PeCO2 was 33 (31-35) mmHg, and VI was 6.0 (6.0-7.0) l/min. After insufflation of CO2 to an IAP of between 14 and 20 mmHg, an increase in VCO2 to 201 (179-222) ml/min was registered (P < 0.05). During mobilisation of the gallbladder, the IAP was between 12 and 18 mmHg and no further increase in VCO2 (200 (179-229) ml/min) was observed. During extraction of the gallbladder from the abdominal cavity, the CO2-PP deflated and IAP dropped to 1-5 mmHg. In this phase, maximal VCO2 and delta VCO2 were measured at 232 (206-245) ml/min and 43 (30-57) ml/min (P < 0.05), respectively. PeCO2 rose to 40 (37-42) mmHg (P < 0.05) although VI was increased to 7.0 (6.0-8.4) l/min (P < 0.05). The complete pattern of VO2 is shown in Fig. 2, the RQ in Fig. 3, and delta VCO2 in Fig. 4. The values of PeCO2, IAP, and VI are listed in Table 2. DISCUSSION. The combination of increased VCO2 and stable VO2 during CO2-PP must be interpreted as indicating resorption of CO2 from the abdominal cavity. Essential CO2 resorption must be assumed during insufflation of the CO2-PP and immediately after a decrease in IAP. During dissection of the gallbladder no increase in CO2 resorption was observed, so the experimental finding [19] can be confirmed clinically that an IAP higher than the venous capillary pressure protects from further CO2 resorption by compressing the venous capillaries of the peritoneum. CO2 resorption is clinically relevant because VI must be increased to maintain normocapnia. Therefore, capnography is absolutely necessary during laparoscopic cholecystectomy.

Adult↗
PubMed1993

[Anesthesia and intensive therapy in autonomic dysfunction].

Familial dysautonomia (Riley-Day syndrome) is a rare genetic disorder that is transmitted via an autosomal recessive gene. The disease, typically involving Jewish children, affects the central nervous system and can be characterised by pathological deficits in peripheral autonomic and sensory neurones. The signs, which begin in early childhood, include poor perception of pain and temperature, poor co-ordination of muscles, emotional crises with hypertension and profound sweating, postural hypotension, and excessive vagal reflexes. We present the case of a 1.5-year-old child who underwent general anaesthesia for gastrostomy and fundoplication because of chronic aspiration. The technique consisted of balanced anaesthesia with invasive monitoring: intra-arterial line, central venous catheter, pulse oximetry, capnography, and monitoring of urinary output, temperature, and metabolic changes. Pulmonary problems included a dramatic decrease in SaO2 during intubation, massive bronchial secretions, and a high fluid requirement. The haemodynamic parameters remained stable. In the postoperative period, pulmonary problems included severe pneumonia with variable pulmonary shunting and requiring an inspired oxygen fraction of between 0.5 and 1.0, accompanied by bronchoconstriction, atelectasis, and profuse bronchial secretions. Controlled ventilation had to be maintained for 4 days. The cardiovascular system was unstable with intermittent episodes of bradycardia, tachycardia, and hypo- or hypertension. The patient also showed signs of autonomic crises, which were treated with diazepam. Although patients with autonomic dysfunction are at high risk in the perioperative period, they can be managed safely when therapeutic efforts are optimised.

Anesthesia, General↗
PubMedDate not supplied

Detection of airway CO2 partial pressure to avoid esophageal intubation.

During endotracheal intubation, checking the position of endotracheal tube is important in order to avoid accidental esophageal intubation. Exhaled CO2 pressures of 50 emergent intubation attempts were recorded in our pediatric intensive unit to evaluate the efficacy of capnography in the early detection of esophageal intubation. Adjustment of the tube position was performed when indicated. In successful endotracheal intubation, the end-tidal CO2 pressures (PetCO2) ranged from 10 mmHg to 80 mmHg with typical respiratory phasic waveforms. In cases of inadvertent esophageal intubation, the PetCO2 values were less than 5 mmHg and revealed no typical respiratory pattern. It was also observed that PetCO2 decreased during one lung intubation or when the tip of endotracheal tube was pulled above the glottis. Capnographic monitoring end-tidal CO2 pressure continuously may be a reliable, time-saving tool for the detection of inadvertent esophageal intubation and the evaluation of proper positioning of the endotracheal tube.

Carbon Dioxide↗
PubMed1993

[Laparoscopic surgery in pediatrics: the point of view of the anesthetist].

Data were collected from a retrospective audit in anaesthetists members of the French Association of Anaesthetists in Paediatrics (ADARPEF) and from the prospective study of the author's practice of appendectomy using open or laparoscopic surgery. Retrospective data obtained in 9 of the 16 answering centres show that contraindications include respiratory disability, cardiopathy and age lower than 5 years when surgical instruments of proper size are not available. Monitoring included electrocardioscope, non invasive arterial pressure, pulse oximetry and capnography. Three centres excluded halothane due to possible cardiovascular concern. In two institutions N2O was omitted to limit the size of potential gas embolism. Intraoperative events included high PETCO2 (37%), high arterial pressure (10%), low arterial pressure (3%), bradycardia (1%), hypoxia (0.5%) and one case of pneumothorax. In the appendectomy series, laparoscopy increased the duration of the procedure, and therefore intraoperative opioids requirements. Arterial pressure was higher in this group, irrespective to intraabdominal pressure and to PETCO2. No significant improvement in postoperative analgesia was found. It is therefore recommended to pay special attention to intraoperative anaesthetic and surgical management of children undergoing laparoscopic surgery, particularly in newborns and infants. The high incidence of minor intraoperative adverse events should be balanced by increased postoperative benefit to the patient which has not yet been demonstrated in children.

Anesthesiology↗
PubMedDate not supplied

A comparison of conventional versus electronic monitoring of sedated pediatric dental patients.

The first purpose of this study was to compare traditional monitoring methods to electronic instruments for monitoring physiologic parameters during conscious sedation of pediatric dental patients. Traditional methods included careful visual assessment of skin color, airway patency and chest movements, and auscultation of breath and heart sounds using a precordial stethoscope; electronic instruments included the capnograph and pulse oximeter. The second purpose of the study was to examine the potential of the capnograph to provide more advanced warning than the pulse oximeter for respiratory compromise. Thirty-nine children (mean age 39 months) received an oral sedative regimen of chloral hydrate, hydroxyzine pamoate, and meperidine and all were supplemented with 100% oxygen via nasal cannula throughout their sedations. One investigator used traditional monitoring and the other used electronic--both monitored simultaneously while being shielded (blinded) from each other. Electronic monitoring yielded a false alert rate of 88% compared with 73% for traditional monitoring. Ten confirmed episodes of respiratory compromise were identified electronically and only three were identified by traditional monitoring. All of the 10 confirmed respiratory compromise episodes were detected by capnography; none were detected by oximetry. During these 39 pediatric sedations using a narcotic drug regimen and 100% oxygen supplementation, there were no true desaturations.

Anesthesia, Dental↗
PubMed1995

[Application of the laryngeal mask in pediatric anesthesiology].

To analyze problems with inserting, maintaining and removing a laryngeal mask in children, as well as to assess the possible involvement of certain factors (experience with the laryngeal mask, type of anesthesia, duration of surgery, type of surgery, obesity, etc.) in favoring the development of complications. One hundred eighty-nine children undergoing a variety of surgical procedures under general anesthesia were studied; patients with full stomachs and/or a history of hiatus hernia were excluded. The agent used for anesthetic induction and the method of ventilation were chosen by the anesthesiologist responsible for each case. Variables monitored in all patients were continuous ECG, heart rate, systolic and diastolic arterial pressure, capnography, pulse oximetry, airways pressure and respiratory rate. Values were recorded at five times: before induction (T1), immediately after induction (T2), after placement of the laryngeal mask (T3), before removing the laryngeal mask (T4) and after removing the laryngeal mask (T5). Correct insertion was achieved on the first try in 85%. The remaining 15% required 2 or more tries. There were no cases in which a tracheal tube or face mask were required. We found no correlation between type or duration of surgery and the occurrence of complications. Complications were more frequent when the laryngeal mask was placed by inexperienced personnel, when inhalational anesthetics were used for induction and maintenance, and when a No. 1 laryngeal mask was used. Adequate ventilation was provided for the patients who required it with an airways pressure between 8 and 18 cmH2O, arterial oxygen saturation over 98% and end-expiratory CO2 pressure under 35 mmHg. Cardiovascular repercussions were slight and hemodynamic stability was good.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Anesthetic and postanesthetic management of sea turtles.

OBJECTIVE: To examine the physiologic effects of inhalation anesthesia in aquatic turtles to improve anesthetic techniques and postanesthetic monitoring. DESIGN: Retrospective case series. ANIMALS: 9 Kemp's ridley sea turtles. PROCEDURE: Isoflurane was used as the general anesthetic during 14 minor surgical procedures. Turtles were orotracheally intubated, and a surgical plane of anesthesia was maintained with 2.7 +/- 0.4% (mean +/- SE) isoflurane. The duration of anesthesia was 131 +/- 12 minutes. Pulse rate, blood pressure, blood gases (PaO2 and PaCO2) and pH, blood lactic acid concentration, and capnography were used to evaluate the physiologic responses of sea turtles to isoflurane. RESULTS: An isoflurane concentration of 3.4 +/- 0.3% provided anesthetic induction in 7 +/- 1 minutes. The mean duration of the recovery phase was 241 +/- 31 minutes. The duration of the recovery phase was not affected by the duration of anesthesia, type of carrier gas, method of ventilatory weaning, or use of selected pharmacologic agents. The recovery phase was characterized by hypoxemia, progressive acidemia, hypercapnia, and lactic acidosis. Awakening in the turtles was preceded by a characteristic tachycardia and tachypnea. All sea turtles recovered from isoflurane anesthesia without apparent adverse effects within 24 hours. CLINICAL IMPLICATIONS: Isoflurane appears to be safe and effective in providing surgical anesthesia in turtles that require a timely return to an aquatic environment. This study should assist veterinarians in predicting the physiologic responses of aquatic turtles to inhalation agents.

Anesthesia, Inhalation↗
PubMed1996

[Use of the laryngeal mask in general anesthesia. Clinical experience].

GOAL OF THE STUDY: To evaluate the use of the laryngeal mask during general anesthesia. STUDY DESIGN: We prospectively studied patients undergoing surgery with general anesthesia in spontaneous breathing. ENVIRONMENT: Urologic and general surgical ward, with standard monitoring equipment. PATIENTS: We studied consecutively 100 patients (ASA 1-3, 80 males, 20 females, age 64 +/- 15 years, range 19-98 years); 59 patients had a preexisting cardiopulmonary or metabolic disease. Monitoring included ECG, the arterial pressure (noninvasive), the CO2 capnography (EtCO2), the pulsossimetry (SpO2), the respiratory rate (RR) and the tidal volume/kg (TVi). The double product (DP = heart rate X systolic arterial pressure) was used as an index of cardiac stress. These parameters were recorded at 10-minute intervals throughout the procedure. RESULTS: The heart rate, the systolic arterial pressure remained stable during the anesthesia, whereas the DP significantly decreased at t10, t20, t30 and t40. The EtCO2 decreased slightly (from 41 +/- 6 to a 36 +/- 4 mmHg; p.n.s.), SpO2 did not change (from 97 +/- 2% to 96 +/- 2%; p:n.s.). The RR significantly increased at t30 and t40 and the TVi significantly increased during the first hour. No relevant complications have been reported. CONCLUSIONS: Anesthesia with laryngeal mask was not associated with any detrimental cardiovascular and respiratory effect.

Adult↗
PubMed1997

[Gas embolism secondary to intraoperative use of hydrogen peroxide].

Hydrogen peroxide solution (H2O2) is used to irrigate and clean wounds. When applied to tissue hydrogen peroxide decomposes rapidly as a result of the action of catalases, releasing oxygen in the process. High pressure irrigation of the washing of closed cavities can cause serious complications. We report a case of gas embolism arising from the use of hydrogen peroxide during surgery for hydatidosis of the liver. A 64-year-old woman underwent surgery for removal of a hydatid cyst of the liver. When pressurized injection of 10 ml of 3% hydrogen peroxide was applied to the cystic cavity, cardiac arrhythmias were observed, a long with decreased PetCO2, hypotension and a "water mill" heart murmur. Gas embolism was suspected and treatment was instated immediately. Clinical course was good and without complications. We wish to warn against the potential dangers of using peroxide during surgery and of the importance of capnography for early diagnosis of gas embolism.

Embolism, Air↗
PubMed1997

[Respiratory changes during laparoscopic cholecystectomy. A comparative study of three techniques].

OBJECTIVES: To analyze the repercussions of CO2 pneumoperitoneum on the ventilation of healthy patients undergoing laparoscopic cholecystectomy; to assess the influence of anesthetic technique and determine whether duration of procedure or CO2 volume are relevant factors. PATIENTS AND METHOD: Prospective study of 132 patients undergoing laparoscopic cholecystectomy. The patients were selected based on disease and level of anesthetic risk and then randomly assigned to three groups to receive anesthesia with oxygen/nitrous oxide (group I), isoflurane in O2 and air (FIO2 0.4) (group II) or propofol in continuous infusion with O2 and air (FIO2 0.4) (group III). Analgesia and muscle relaxation were the same in all groups. Monitoring included blood pressure (BP), heart rate (HR), electrocardiography (ECG), central venous pressure (CVP), capnography (PETco2), pulse oximetry (SaO2), peak airways pressure (PAP), FIO2, intra-abdominal pressure (IAP), volume in insufflated CO2 and serial gasometry. Readings were taken before pneumoperitoneum after 20 minutes and every 30 minutes until end of surgery. After surgery parameters were recorded four more times at intervals of 30 minutes. RESULTS: The groups were homogeneous. pneumoperitoneum caused a decrease in PaO2 (p < 0.001) and SaO2 and increases in PaCO2, PETco2 and CVP, although levels later stabilized. No relation was found between duration of pneumoperitoneum or CO2 volumen and any of the changes observed. Group I had the lowest mean PaO2 before pneumoperitoneum and 60 minutes later (p < 0.05). Group II had the smallest increase in PaCO2, although the difference was non significant. CONCLUSIONS: CO2 pneumoperitoneum caused ventilatory changes dependent on uptake and increased abdominal pressure. The duration and volume of CO2 used did not influence the parameters studied. The clinical significance of these changes is slight in the healthy patient. The anesthetic agents used did not have substantial effects.

Adult↗
PubMed1997

[Successful use of propofol for anesthesia for plasty of eyelids in epidermolysis bullosa].

A 21-year-old male with recessive dystrophic epidermolysis, required anesthesia for plastic surgery of eyelids. We took special care for the attachment of monitoring equipment and placing an intravenous cannula. Anesthesia was induced by intravenous propofol 1 mg.kg-1 and maintained with local injection of 1.0% lidocaine and continuous infusion of propofol 3-4 mg.kg-1.hr-1. Tracheal intubation was not performed and oxygen was given through a nasal cannula and spontaneous breathing was maintained throughout the anesthetic management. Respiratory condition was monitored by measuring Spo2 and end-tidal CO2 by capnography obtained from the nasal cannula. Operation was performed successfully and he was discharged without any major complications.

Adult↗
PubMed1998

[Laparoscopic surgery in children].

OBJECTIVE: We summarize our experience in laparoscopic surgery between 1992 and 1997 in an attempt to provide the pediatrician with up-dated information regarding the background, technical basis and limitations of this procedure in children. PATIENTS AND METHODS: For our 315 operations we used conventional endoscopic equipment with miniaturized instruments and regular anesthetic procedures assisted only with on-line capnography and increased tidal volume. Ages ranged between newborn and adolescence and the main indications for surgery were gonadal operations (n = 113), fundoplication (n = 40), cholecystectomy (n = 35), exploration for recurrent abdominal pain (n = 44) and appendectomy (n = 29), but we also performed spleenectomies (n = 7), nephrectomies (n = 6), rectosigmoidectomies (n = 4) and several other procedures. RESULTS: Complications were scares [4 major (1.2% and 17 minor (5.3%)] and were satisfactorily solved. The conversion to an open operation was felt necessary in only 7 instances (2.2%) and this approach has been fully rewarding in terms of good results, little pain, short hospital stay and rapid recovery. CONCLUSIONS: Laparoscopic surgery is already a realistic alternative in pediatric medicine and its indications are growing every day as a result of its widespread use. The pediatrician has to be aware of the opportunity, rationale and limits of this approach since he will be increasingly confronted with it.

Adolescent↗