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PubMedDate not supplied

[The evolution of respiratory reanimation as seen by the drowned].

In addition to anecdotal techniques born from Galen reasoning, the method of recovering apparently drowned persons in the XVIIIth century surprises by the use of present techniques of artificial respiration. However, for over a century, these techniques was left on behalf of manual methods until the sixteens. In the XVIIIth century, resuscitation involves two principles: stimulation and artificial respiration. Amid stimulation, in addition to warmth, the choice treatment was to blow tobacco smoke into the rectum, which was used until the beginning of the XXth century. Inflation of the lungs was practised with mouth-to-mouth, and endotracheal or nasal intubation or tracheostomy with bellows, pistons or bladders, and the use of oxygen. But J. Leroy d'Etiolles, in 1827, demonstrated to the académie des Sciences the iatrogen peril of the inflation of the lungs, and the risk to leave the people sophistical techniques without education. This transaction gave the alarm to the european philanthropic Societies which stood down the inflation of lungs in the method of recovering apparently drowned persons. Between 1830 and the sixteens, inflation was put in the place of "forced expiration" techniques: the famous Sylvester or Schaeffer methods. From the outset of the XXth century, oxygen is used widely by helpers, and physicians have elaborated subcutaneous and intravenous ways of infusion to this oxygen. It is only in 1958 that Safar and al. demonstrated mouth-to-mouth superiority in relation to chest compressions.

Drowning↗
PubMed1989

Anesthetic effects on tonic and reflex renal sympathetic nerve activity in awake cats.

Renal sympathetic nerve activity (RNA), arterial blood pressure (AP), and heart rate (HR) were simultaneously measured before and after administration of pentobarbital sodium (PB), chloralose (CHL), or urethan (URE) in conscious cats. We examined the time courses and magnitudes of the changes in RNA, AP, and HR over a period of 5 h under anesthesia with spontaneous or artificial respiration. In both respiratory conditions, PB initially decreased and then increased RNA, AP, and HR; CHL sustainedly increased RNA but had almost no effect on AP and HR. Under artificial respiration, URE transiently decreased RNA but had no effect on AP and HR. To examine the baroreflex response of RNA, AP was increased to 150 mmHg by norepinephrine and decreased to 65 mmHg by nitroprusside. RNA responded inversely to the alterations of AP in both awake and anesthetized states. Compared with the awake state, the inverse AP-RNA relationship curve initially shifted downward and then upward under PB, and the slope of the relation curve was initially decreased. On the other hand, under CHL the relationship curve shifted only upward, and the slope increased. Thus the anesthetic drugs affected differently and time dependently tonic and reflex renal sympathetic nerve activity in the conscious cat.

Animals↗
PubMed1999

[Neurologic development of children at age two who had been treated at a neonatal intensive care unit].

The principal objective of this study was to evaluate, at 2 years of age, the neurological development of a group of children who had been treated in the neonatal intensive care unit (NICU) of the National Institute of Perinatology of Mexico. All the children born between 1 January 1992 and 31 December 1993 who had entered the NICU and stayed for 3 or more days were studied from the neurological, psychological, auditory, linguistic, motor, and neuromuscular standpoint. This group included 134 patients, who had had an average gestational age of 32 weeks and an average birth-weight of 1,677 g. They had stayed in the hospital an average of 51 days, and 75% of them had undergone artificial respiration. In the examination done at age 2, 66.5% of the children were normal and 8.2% had serious impairments. There were statistically significant associations between their neurological condition and the days of artificial respiration (P < 0.0001), the days spent in the NICU (P < 0.000004), and the gestational age in weeks (P < 0.03). There was no association between the children's sex and the results of the assessments. The study results showed a decrease in neural abnormalities in comparison with the results obtained in similar studies 10 years earlier.

Child Development↗
PubMed1976

[Neuro-psychological development of a group of children with neonatal respiratory distress treated with intermittent positive-pressure respirator].

The first results of long-term evolution of 99 children, most of which were premature, and who survived after intermittent positive pressure respiration for hyaline membrane disease, have been analyzed. No matched series could be set up. With a follow-up ranging from 3 1/2 years to 6 years, 51% of the children were normal, 12.5% presented with severe neurological and psychological sequellae, 31% had acceptable, sometimes slight handicap. As compared with series of the literature, prognosis was improved with intensive care and artificial respiration. This is far more obvious for the children at stage III, of which none survived without artificial respiration.

Child↗
PubMedDate not supplied

Differential cardiovascular effects mediated by mu and kappa opiate receptors in hindbrain nuclei.

To further investigate the role of opioid peptides and specific opiate receptor subtypes in central cardiovascular regulation by hindbrain nuclei, mu (D-Ala2,MePhe4,Gly-ol5 enkephalin, DAGO), delta (D-Ala2,D-Leu5 enkephalin, DADL) or kappa (MRZ 2549) agonists were microinjected into hindbrain nuclei of spontaneously or artificially respired, pentobarbital-anesthetized rats. In the nucleus tractus solitarius (NTS), DAGO and DADL (0.3 nmol) elicited pressor responses and tachycardia. MRZ (3.0-16 nmol) depressed blood pressure in spontaneously breathing rats, but accelerated heart rate in artificially ventilated animals. Blood pressure and heart rate of spontaneously breathing animals were not altered following nucleus ambiguus (NA) injection of DAGO or DADL (0.3 nmol), but were elevated in artificially respired animals; MRZ (3.0-10 nmol) injected into the NA depressed blood pressure in both groups. These data suggest that in the absence of respiratory depression, NTS and NA mu receptors mediate pressor responses and tachycardia; kappa receptors in the NA mediate a decrease in blood pressure but cardioacceleration in the NTS.

Animals↗
PubMed1989

[Physiological parameters of guinea pigs under long-term anesthesia with controlled respiration].

56 guinea pigs were anesthetized with a mixture of alpha-chloralose and a small dose of ethyl urethane injected i.p. in order to compare the chloralose-urethane anesthesia with neuroleptanesthesia, a mixture of droperidol-fentanyl and a small induction dose of Na-pentobarbital was injected i.p. to 14 animals. All animals were maintained at constant body temperature of 38 degrees C and artificially respirated via a tracheal cannula monitoring the end expiratory CO2 concentration. Mean arterial blood pressure (carotid artery) and heart rate were continuously recorded. Arterial acid-base status and pO2 were tested. Mean arterial blood pressure and heart rate were found to be somewhat higher in the neuroleptanesthetized animals. Under chloralose-urethane anesthesia and neuroleptanesthesia the mean arterial blood pressure amounted to 56 and 62 mm Hg, respectively. These findings correspond to data given in the literature concerning the mean pressure in unanesthetized guinea pigs. The mean heart rates of 295 and 316 min-1, respectively are somewhat higher compared to the normal range. Under both anesthesias, the arterial acid-base status was within the normal limits of unanesthetized animals. The mean arterial pO2 of 80.9 and 76.5 mm Hg was relatively low. The present studies have shown that chloralose-urethane as well as droperidol-fentanyl with pentobarbital are useful, under controlled artificial respiration, to achieve long-term anesthesia maintaining nearly normal systemic circulatory and respiratory conditions.

Anesthesia↗
PubMed2004

Envenoming by the common krait (Bungarus caeruleus) and Asian cobra (Naja naja): clinical manifestations and their management in a rural setting.

OBJECTIVE: Villagers are commonly poisoned by kraits and cobras in India, and resulting deaths are common. An inadequate understanding of appropriate snakebite treatment often delays proper treatment of those who are bitten. A lack of simple airway management equipment such as resuscitation bags and laryngoscopes compounds the difficulty in treating many patients and increases mortality in neurotoxic (elapid) venom poisoning. This article discusses the clinical signs and symptoms of krait and cobra envenoming and medical intervention in a rural setting. METHODS: We enrolled 30 subjects of presumed snake envenoming (krait = 23 cases, cobra = 7 cases). Details of the bite site, the subject's activities at the time of the bite, local manifestations, systemic involvement, progress of venom poisoning, and subsequent response to treatment were collected on a standard data form. The type of snake was confirmed either by analyzing the killed specimen or by combining clinical findings and identification by the subject or bystanders when presented with preserved specimens. RESULTS: Of 23 subjects (11 male, 12 female) bitten by kraits, 2 were deceased upon arrival, 7 died in the hospital, and 14 recovered. Of the 14 survivors, 4 required artificial respirations with a resuscitation bag, antivenom, and anticholinesterase drugs. One had a dry bite. The remaining 9 recovered with supportive treatment only. Of 7 subjects (5 male; 2 female) encountering cobras, 2 who had been bitten were deceased upon arrival at the hospital, and 1 died suddenly of an apparent cardiac arrest after seeing a hooded cobra on a road (there was no evidence of a bite site on this individual). Four subjects recovered with antivenon, anticholinesterase drugs, and/or artificial respiration. CONCLUSION: Early administration of antivenom prevents respiratory paralysis after elapid snake bite. Patients with evidence of respiratory insufficiency after neurotoxic venom poisoning require rapid intubation and artificial ventilation. Anticholinestrase agents may help reverse neuromuscular dysfunction caused by elapid envenoming and may accelerate recovery.

Adolescent↗
PubMed1974

Interstitial pulmonary edema following bromocarbamide intoxication.

Bromocarbamides are sleep-inducing drugs which can lead, in man, to intoxication and death due to respiratory failure. To prove whether hemodynamic factors or the changed endothelial permeability induce pulmonary edema, animal experiments were performed. The fine structural changes in pulmonary edema in rabbits were observed at 60, 90 and 120 minutes after oral administration. The major findings were a) large blebs between capillary endothelium and alveolar epithelium and b) interstitial edema of the vessel wall. The bleb contents were much less electron dense than the blood contents in the capillary. Colloidal carbon did not enter the bleb or the edematous interstitial tissue. Exogenous peroxidase uptake in pinocytotie vesicles increased in pathologic cases. The hemodynamic measurements in animal receiving artificial respiration which maintained the blood pO(2) at a steady state showed similar blebs in the pulmonary vessels, indicating that anoxia is not the major cause of the vascular lesion. Moreover, pulmonary arterial pressure and pulmonary vascular resistance could be held in the normal range in artificially respirated animals under bromocarbamide intoxication. Thus, hemodynamic factors are not likely to play a pathogenetic role in bringing about pulmonary edema. The chief, early factor is the increased endothelial permeability due to increased cytoplasmic transport. From this a practical suggestion for treating patients with bromocarbamide intoxication is derived: the usual fluid replacement in shock patients should be handled with great care to avoid fluid overload of the lung.

Adrenal Glands↗
PubMed1984

Timbós: ichthyotoxic plants used by Brazilian Indians.

The pharmacology of serjanosides, active principles isolated from the fish-poison plant Serjania lethalis St. Hil, a Sapindaceae, was investigated by comparing their actions in fishes and mammals with those of rotenone and certain saponins. The ichthyocid activity of the serjanosides was 2.5 times greater than that of the crude plant extract, approximately 10 times lower than the activity of rotenone, but from 10 to 50 times greater than the activity of the other saponins. When injected in mammals, the serjanosides induced deep prostration, dyspnea, cyanosis, ectopic heart beats, cardiovascular failure and respiratory arrest. These effects, leading to death that was not prevented by artificial respiration, indicated several mechanisms for the toxic action of the serjanosides. In vitro studies with these substances have shown that membrane depolarization and muscle contracture were probably due to unspecific surface actions. Rotenone, under the same experimental conditions induced hypotension, bradycardia and respiratory arrest. Death was prevented by artificial respiration. Ectopic foci, membrane depolarization, contractures and neuromuscular block were not observed after rotenone. Apparently, death from rotenone poisoning was a consequence of respiratory failure of central origin. The serjanosides are rather potent fish poison saponins. Mammals, however, are apparently insensitive to the same specific action since other toxic effects induced by those substances in rats and mice were also observed by employing saponins devoid of fish-killing activity.

Animals↗
PubMed2006

Toxic and lethal effects of ostreolysin, a cytolytic protein from edible oyster mushroom (Pleurotus ostreatus), in rodents.

Ostreolysin (Oly), an acidic, 15 kDa protein from the edible oyster mushroom (Pleurotus ostreatus), is a toxic, pore-forming cytolysin. In this paper, its toxic properties have been studied in rodents and the LD(50) in mice shown to be 1170 microg/kg. Electrocardiogram, arterial blood pressure and respiratory activity were recorded under general anaesthesia, in intact, pharmacologically vagotomised and artificially respirated rats injected with one mouse LD(50). A few seconds after intravenous Oly injection, a transient increase in arterial blood pressure was recorded, followed by a progressive fall to mid-circulatory pressure accompanied by bradicardia, myocardial ischaemia and ventricular extrasystoles. Similar changes produced by Oly were observed in vagotomised and artificially respirated animals, indicating that vagotomy and hypoxia play no primary role in toxicity. Oly induced lysis of rat erythrocytes in vitro, and probably also in vivo as indicated by the increase in serum potassium. Although direct action of the protein on the cardiomyocytes or heart circulation cannot be excluded, the hyperkalaemia resulting from the haemolytic activity probably plays an important role in its toxicity. The lethality and cardiorespiratory toxic action of Oly are thus shown to be candidates for the cause of the recorded adverse effects of oyster mushroom.

Animals↗
PubMed1986

Brain anoxia releases striatal dopamine in rats.

Immediately following death resulting from discontinuance of artificial respiration in anesthetized rats, a large increase in electrochemically reactive materials in the extracellular fluid was detected by in vivo voltammetry with an electrode in the striatum. The use of in vivo brain dialysis permitted identification of the reactive material as dopamine. The release of dopamine occurred about 6 minutes after cessation of artificial respiration and death. A similar release of dopamine was found after intrastriatal ouabain administration. A large release of dopamine might result in irreversible tissue damage in certain pathological conditions such as stroke or anoxia.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1976

Blood pressure responses as an indicator of the anesthetic level in ground squirrels.

In many experiments in visual physiology which employ halothane anesthesia, it is difficult to judge accurately an animal's anesthetic state, particularly so because of the necessity for paralysis and artificial respiration. For the ground squirrel (Citellus tridecemlineatus and C. mexicanus), we find that measures of arterial pressure response to a noxious stimulus combined with mean arterial pressure allow for an accurate division of halothane anesthetic state into five stages. All five stages are identified and are the same regardless of whether the animal is unparalyzed or is paralyzed and artificially respired. Use of these measures in long-term experiments allows for recognition of and adjustment for small perturbations of anesthetic state that may occur even though inhaled halothane concentration remains constant.

Anesthesia↗
PubMed1993

[Three cases of a fulminant course of idiopathic pulmonary fibrosis (Hamman-Rich syndrome)].

The Hamman-Rich syndrome is defined as an acute pulmonary disease of unclear aetiology that takes a rapid and prognostically unfavourable, usually fatal course. We report on three patients admitted to the intensive-care ward during a period of 6 months in a state of mandatory artificial respiration, each patient dying within 3 weeks after admission. Basing on clinical and histological criteria these patients were diagnosed as suffering from Hamman-Rich syndrome. At the time of the clinically identifiable onset of the disease all the patients had fever (> 39 X), leucocytosis (> 20 x 10(3)/microliters) and dyspnoea. These signs and symptoms were at first, in conjunction with the radiological identification of diffuse pulmonary infiltrations, misdiagnosed as pneumonia. The patients had to be artificially respirated after a short time because of the foundroyant course of the disease. Despite optimised respiratory parameters it was already initially apparent that there was a severe disturbance of the gas exchange function (paO2/FiO2 < 150) and high respiratory pressures (> 40 mmHg). Polymorphonuclear neutrophilics dominated in the bronchoalveolar lavage. Lung biopsy showed marked fibrosing that was a decisive factor in diagnosing. An infectious agent as triggering cause of the disease could not be identified in any of the patients. Treatment was effected with antibiotics, steroids and cyclophosphamide. The patients died after 14, 17 and 21 days, respectively, from intractable respiratory insufficiency with increasing loss of compliance of the lungs (compliance of lungs and thorax < 20 ml/mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

[Surgery in the last 40 years: looking back in wonder].

Much has changed in surgery in the last 40 years: From the fifties, new findings were introduced, such as antibiotics, anticoagulants, cytostatics, cardiac and pulmonary surgery, artificial respiration, osteosynthesis, arteriography, synthetic fibres and image intensifying in the clinic. The average hospital stay in the surgical ward used to be 21 days, mortality 6-7%. Owing to the long hospital stays, nurses, physicians and interns grew familiar with the pre- and postoperative courses. In the sixties, reconstructive vascular surgery became possible, where earlier limbs had to be amputated. The first pacemakers were inserted. There was widespread lung surgery because of tuberculosis, and owing to the great poliomyelitis epidemic of 1953, there was ample expertise of artificial respiration. Surgical treatment of fractures took off, and the first hip prostheses were introduced. The average hospital stay shrunk to about 14 days and the mortality to less than 2%. A turning point in surgical management came in 1961. In that year, the free Saturday was introduced, marking a transition from austerity to luxury. The medical successes were overtaken by the patients' needs, expectations and claims. Physicians started to work fixed hours, rather than when required. The seventies saw the beginning of intensive care and great progress in paediatric surgery; organ transplantation came in the eighties. The recent years were marked by formalization and protocolling of treatment and information. The growing influence of the government and of bureaucracy, and the encroachment upon the surgeon's social position and income interfere with his work with the patients.

General Surgery↗
PubMed1989

[Repair of complete atrioventricular canal before one year of age].

We report a series of 22 children with complete atrioventricular canal (CAVC) operated upon before the age of one year. The youngest patient was 1 month old and weighed 3 kg. The patients' mean age was 7 months and their mean weight was 5.4 kg. 15 patients had trisomy 21, and in one patient the CAVC was associated with tetralogy of Fallot. The remaining 21 patients had congestive heart failure resistant to medical treatment, with clinical evidence of pulmonary arterial hypertension (PAHT). At the time of surgery, 2 patients had been under artificial respiration for one month. All patients were explored by echocardiography and cardiac catheterization. The mean pulmonary pressure/aortic pressure ratio was 0.92; the mean pulmonary flow rate/systemic flow rate ratio (Qp/Qs) was 2.9/1 and the mean pulmonary resistance/systemic resistance ratio (Rp/Rs) was 0.22. All children were operated upon under deep hypothermia with circulatory arrest (mean 54 min); the patient with tetralogy of Fallot had an additional period of extracorporeal circulation. Fourteen patients had Rastelli's type A CAVC and 8 had type C CAVC. All were operated upon by the classical Rastelli technique, using a single autologous pericardial patch; in none of the patients was the septal "slit" or "commissure" entirely closed. Three patients died within 48 hours of the operation: the first one died of sudden low cardiac output 18 hours after surgery, the second one of persistent PAHT and the third one of malignant hyperthermia. The patient under artificial respiration before surgery could not be disconnected and died on the 30th post-operative day.(ABSTRACT TRUNCATED AT 250 WORDS)

Heart Defects, Congenital↗
PubMed1975

[Tracheo-bronchial aspiration of foreign material by the unconscious patient (author's transl)].

180 cases of head trauma were classified according to the degree of impairment of consciousness, clinical and neurological symptoms and EEG patterns. Based on the radiological and clinical findings and blood gas analyses a study was made of the incidence and extent of aspiration of blood, vomit or debris into the tracheo-bronchial tree and of the resultant pulmonary complications. As loss of consciousness became more complete the incidence of aspiration and the amount of material inhaled increased. Clinically and radiologically proven aspiration occurred in 60 per cent of cases of severe head trauma. A comparison of two groups after they had been given first aid and artificial respiration showed that the paO2 values were significantly lower in patients with radiologically proven aspiration and infiltration of the lungs than they were in those with normal chest radiograms. These observations point to the relationship between the quantity of material inhaled and the extent of intra-pulmonary shunting. There was no difference in the incidence of aspiration between persons who had been intubated and those who had not been intubated prior to admission to hospital. Although in many cases of head trauma aspiration of blood immediately after the accident can not be prevented prompt intubation is the only measure that will mitigate the consequences of aspiration and prevent its recurrence. As the latter is a very real risk in the unconscious person intubation in these cases is a "must". The study also showed that aspiration of foreign material into the tracheobronchial system and the resultant pulmonary complications can be successfully treated even if the head trauma is very severe. In none of the cases studied was death attributable to these causes. Apart from intubation and bronchial toilet artificial respiration with oxygen-enriched gas mixtures has a decisive influence on the course of the aspiration-induced pulmonary complications.

Adult↗