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At least 1,333 records · Page 74Linked to original sources
PubMed1986

Physiologic and electrocardiographic responses of American river otters (Lutra canadensis) during chemical immobilization and inhalation anesthesia.

Rectal temperatures and heart rates of American river otters (Lutra canadensis) decreased significantly (P less than 0.05) during chemical immobilization with i.m. ketamine hydrochloride in combination with xylazine hydrochloride and acepromazine and during inhalation anesthesia with isoflurane. Anesthetized otters showed a tendency for apnea during induction and while dorsally recumbent, which was reflected by a respiratory acidosis on arterial blood gases. Declines in rectal temperatures and heart rates were not found to be a function of dosage (mg/kg) of the ketamine combination used except for rectal temperatures of otters in relatively poor body condition (inanition). The electrocardiograms of isoflurane-anesthetized otters were similar to those recorded on immobilized otters with the exception of an r' deflection in the ventricular depolarization complex (RSr'). Electrocardiographic criteria were not found which predicted the degree of right ventricular or generalized cardiac enlargement seen radiographically.

Anesthesia, Inhalation↗
PubMed1976

[Cerebrospinal fluid changes in severe craniocerebral injury and their therapy].

The sign of a traumatically caused alveolar hyperventilation in severe cranio-cerebral injury is a respiratory alcalosis as well as hypoxia and hypoxemia in the arterial as well in the cerebral veneous blood. The combination of decreased oxygen tension or saturation and hypocapnia can exist for several days and in a lethal course transform into a combined metabolic respiratory acidosis with increasing carbonic acid tension and so initiate the prefinal state. The extremely pathological blood gases are usually the first sign of shock-specific changes of the lung. The most impressing changes of the cerebrospinal fluid are the metabolic acidosis in combination with a diminished oxygen tension and tissue hypoxia of the brain. The acidosis of cerebrospinal fluid in severe brain injury is not only of prognostic but also of therapeutical importance. The treatment of the acidosis of cerebrospinal fluid by intrathecal administration of buffering substances in severe brain injuries and its sequelae can have a favourable influence on the cerebral circulation and brain metabolism.

Acid-Base Equilibrium↗
PubMed1998

[Effective nasal CPAP therapy for heavy snoring and paradoxical respiration during sleep in a case of multiple system atrophy].

A 64-year-old man with multiple system atrophy complained of daytime sleepiness, fatigue, and snoring. Neurological examination revealed severe autonomic failure, mild cerebellar ataxia and akinesia. Daytime blood gas analysis showed respiratory acidosis with hypoxia and hypercapnia. MR imaging of the brain showed atrophy of the pons, cerebellum and bilateral frontal lobes. Although paralysis of the vocal cord abduction was not found by laryngoscopy during daytime examination, polysomnography (PSG) showed heavy snoring with paradoxical respiration associated with severe desaturation during sleep as well as reduced slow wave sleep and REM sleep. He was diagnosed as having sleep-related upper airway obstructive breathing disorder probably due to Gerhardt syndrome. Tracheostomy was considered, but we performed nasal CPAP therapy during sleep because this therapy is non-invasive and would not impair his daily life. After nasal CPAP therapy, daytime sleepiness, fatigue, and snoring with desaturation improved, and PSG showed increased slow wave sleep. These results demonstrate that nasal CPAP therapy improves the quality of sleep and should be considered in patients with early stages of multiple system atrophy who exhibit sleep-related breathing disorders.

Humans↗
PubMed1999

[High-frequency jet ventilation with a proximal injector in a case of surgery of the tracheal carina].

A 44-year-old man underwent surgery requiring medial sternotomy of resection of a tracheal carcina tumor. High frequency jet ventilation was used during tumor resection and reconstruction of the carina in order to shorten the time of surgery and to provide a nearly immobile and unobstructed surgical field. The only noteworthy complication was a tendency to respiratory acidosis that resolved without sequelae in the operating room once the trachea was closed. The anesthetic challenges presented by the various techniques used throughout history for such an interesting and complex type of surgery are briefly summarized. We also discuss the role of high frequency jet ventilation on surgery involving the major airways.

Adult↗
PubMed1999

Post-extubation prophylactic nasal continuous positive airway pressure in preterm infants: systematic review and meta-analysis.

OBJECTIVES: To determine whether management with nasal continuous positive airway pressure (NCPAP) in preterm infants having their endotracheal tube removed following a period of intermittent positive pressure ventilation (IPPV), leads to an increased proportion remaining free of additional ventilatory support, compared to extubation directly to headbox oxygen. METHODOLOGY: Search Strategy - Searches were made of the Oxford Database of Perinatal Trials, Medline, abstracts of conferences and symposia proceedings, expert informants, journal hand searching mainly in the English language and expert informant searches in the Japanese language. Selection criteria - All trials utilising random or quasi-random patient allocation, in which NCPAP (delivered by any method) was compared with headbox oxygen for postextubation care were included. Methodological quality was assessed independently by the two authors. Data collection and analysis - Data were extracted independently by the two authors. Meta-analysis using event rate ratios (ERRs) and event rate differences (ERDs) was performed using Revman 3.0 statistical software. Prespecified subgroup analysis to determine the impact of different levels of NCPAP and use of aminophylline were also performed using the same package. Similar analysis to investigate the effect of postnatal age on outcomes of interest was also undertaken. RESULTS: Nasal CPAP, when applied to preterm infants being extubated following IPPV, reduces the incidence of adverse clinical events (apnoea, respiratory acidosis and increased oxygen requirements) indicating the need for additional ventilatory support. This result is both statistically significant and clinically important; ERR, 0.62 (0.49, 0.79) and ERD, - 0.175 (- 0.256, - 0.095). A trend towards reduction in the incidence of oxygen dependency at 28 days of age is also seen in the group extubated to NCPAP; ERR, 0.86 (0.67, 1.10) and ERD, - 0.069 (- 0.177, 0.039). CONCLUSION: Nasal CPAP is effective in preventing failure of extubation in preterm infants following a period of endotracheal intubation and IPPV. Further definition of the patient gestational age and weight groups to whom these results apply is required. Optimal levels of NCPAP as well as methods of administration remain to be determined.

Aminophylline↗
PubMed1999

[Changes in acid-base equilibrium, ventilation parameters and immunologic reactions in thoracoscopic operations].

In the thoracoscopic operations it is usually necessary to deflate completely the ipsilateral lung. The aim of this study was to determine changes of blood gases and alterations of immune response mediators during thoracoscopic surgery with one-lung ventilation OLV. In the study 38 patients were included undergoing thoracoscopic or video-assisted thoracic surgery. Arterial blood gases, respiratory parameters, heart rate, blood pressure were determined before one-lung ventilation, at the peak of operation and after finishing OLV. The circulatory cytokines IL-1 beta, IL-2, IL-6, IL-8, TNF-alpha, and reactive oxygen species (ROS) were measured before and after operation, 3 h, 24 h and 48 h after operation. The obtained variables were statistically evaluated. One-lung ventilation caused a significant increase of PaCO2 (from 4.69 +/- 0.67 to 5.91 +/- 0.87 kPa) which was accompanied by an adequate decrease of pH (7.455 +/- 0.033-7.368 +/- 0.037) and a number of patients developed respiratory acidosis (34%). There were no significant changes in levels of the investigated cytokines, only a mild increase of IL-6, IL-8 and TNF during first 24 h after operation was observed. The activity of ROS was highest at the end of the operation, but did not differ significantly from the start, but then decreased significantly for a period of 24 h. The authors conclude that the observed increase of carbon dioxide levels and decrease of pH had no impact on the fate of the patients. Thoracoscopic or VATS procedures were a minimal load for patients causing no significant changes of proinflammatory cytokines. The operations did not significantly elevate the activity of ROS.

Acid-Base Equilibrium↗
PubMed2000

[Successful weaning from mechanical ventilation in an infant with congenital tracheal stenosis and bronchial malacia using endobronchial stent, nasal CPAP and continuous sedation].

A 1.9 kg male infant who showed respiratory distress at his birth, was diagnosed by bronchoscopy as having congenital segmental stenosis of trachea with complete ring. Tracheoplasty was performed and the infant was admitted to ICU. After admission to ICU, we suspected the residual tracheal stenosis and the left main bronchial malacia by bronchoscopy. Although we tried to wean him from mechanical ventilation, but failed and re-intubated him four times because of marked respiratory acidosis after extubation. Bronchoscopy was performed repeatedly, and the residual tracheal stenosis and the left main bronchial malacia were apparent. After patch tracheoplasty of the costal cartilage to the residual tracheal stenosis and implantation of angioplastic expandable metallic stent to the left main bronchus, he was successfully extubated under continuous sedation. In addition, nasal CPAP was effective to reduce retraction and wheezing after extubation. He was discharged from ICU on the 183rd ICU day.

Bronchi↗
PubMed2000

Endoscopic resection of thyroid tumors by the axillary approach.

One of the problems of surgery in the neck is the scar. Endoscopic surgery has recently been applied to cervical exploration and the scars of the neck are small and inconspicuous, but a few patients still complain of it. For this reason, we developed a technique of endoscopic resection of thyroid tumors using an axillary approach. This approach does not leave a scar on the neck or the chest, and the small scar in the axilla is completely covered by the patient's arm in a natural manner. Furthermore, the complications such as hypercapnia, respiratory acidosis, subcutaneous empysema, air embolism and sensory loss in the neck region are minimized, because the working surgical space is small and procedures can be performed with CO2 insufflation levels below 4 mmHg. We believe that endoscopic surgery by the axillary approach will find a role in the treatment of thyroid tumors

Endoscopy↗
PubMed1975

Induced hypercapnia in experimental hemorrhagic shock.

The inhalation effect of a 90% oxygen and 10% carbon dioxide mixture was compared with pure oxygen inhalation in the treatment of rabbits, bled to a mean arterial pressure of 25 mmHg. A pronounced respiratory acidosis developed in the O-2-CO-2-treated rabbits. Both groups showed similar changes in the blood concentration of lactate and the base deficit values. In the rabbits inhaling O-2-CO-2, the PvO-2 was significantly higher than in those treated with oxygen. All the relationships were recorded independent of the time of onset of the inhalation treatment regardless of whether it was commenced before or after the bleeding. Our conclusion is that, in spite of the apparent increase in the shunting of oxygenated blood to the venous circulation, the perfusion through the capillaries is unaffected by the carbon dioxide inhaled in hemorrhagic shock.

Animals↗
PubMed1975

Current trends in ophthalmic anesthesia. The Second Walter S. Atkinson Lecture.

General anesthesia permits surgery involving large operative fields without limit to time. It is essential in children and uncooperative adults and provides an immobile, quiet patient who does not recall the operative procedure. Local and regional anesthesia re indicated when the surgical field is limited in size and extent. Neuroleptanesthesia in ophthalmology usually involves the administration of droperidol followed by fentanyl followed in intubation, sometimes using a muscle relaxant, and maintenance of anesthesia with nitrous oxide. The terrifying dreams produced by ketamine may be minimized by preoperative administration of diazepam and a quiet recovery period. Attempts to eliminate the oculocardiac reflex are unpredictable and unreliable and, with careful monitoring of anesthesia, elimination does not seem essential. Malignant hyperthermia is an autosomal dominant disorder occurring mainly with the administration of halogenated fluoroethane and depolarizing muscle relaxants. It is often signaled by sudden and prolonged muscle spasm following the injection of the muscle relaxant. Treatment must be directed toward hyperventilation using oxygen, correction of the metabolic respiratory acidosis, and reduction of fever.

Anesthesia, General↗
PubMed2001

Disruption of gas exchange in mice after exposure to the chemical threat agent phosgene.

The use of chemical warfare agents, such as the pulmonary irritant gas phosgene, is a real and constant threat not only from belligerent nations but from terrorist groups as well. Phosgene is both easy and inexpensive to produce and as such is a potential candidate for use as a threat agent. Phosgene attacks the deep lung after inhalation and can severely compromise pulmonary mechanics and gas exchange, rendering the exposed individual incapacitated. If exposure is severe, death can ensure by asphyxiation secondary to pulmonary edema formation. This paper examines the effects on lung tissue in mice over 24 hours after exposure to the irritant gas phosgene. Exposure to phosgene produced respiratory acidosis by decreasing pH, partial pressure of oxygen, O2 saturation, and increasing partial pressure of carbon dioxide. Exposure to phosgene also induced temporal increases in lung tissue gravimetric parameters such as lung tissue wet weight/dry weight ratio, which is a positive indicator of pulmonary edema formation, and dry lung weight, an indicator of lung cellular hyperaggregation. Blood gases and pH tend to normalize within 24 hours, whereas gravimetric parameters remain increased. Temporal changes in these physiological indicators of lung injury may help to explain why past exposures to phosgene required lengthy hospitalization.

Analysis of Variance↗
PubMedDate not supplied

[General anesthesia and ventilation of the lungs in endoscopic surgery of tumors of the larynx, trachea and bronchi].

Clinical study was carried out during 116 total anesthesias for endoscopic operations on the larynx, trachea, and bronchi. Multicomponent total anesthesia was based on fentanyl, calypsol, diprivane, and dormicum microdoses in combination with local lidocaine anesthesia of the airways and premedication with nonsteroid antiinflammatory drugs. Interventions on the larynx and proximal part of the trachea were carried out with the patients' spontaneous respiration retained; during interventions on the middle part of the trachea, forced ventilation of the lungs (FVL) was carried out through an intubation bronchoscope; and during total anesthesia for operations on the tracheal bifurcation, high-frequency FVL of the intact lung was carried out. Stable hemodynamics and gas exchange, hypercapnia, and moderate respiratory acidosis were observed in patients operated on under both types of FVL. No serious complications during and immediately after surgery and anesthesia were observed. Hence, the choice of the method of total anesthesia and ventilation of the lungs in endoscopic interventions on the airways depends on the level of lesions and degree of airway obstruction.

Adult↗
PubMed2001

[Histopathological changes of lung and right ventricle induced by high concentration of carbon dioxide in rats].

OBJECTIVE: To evaluate if high concentration of carbon dioxide causes any histopathological changes of the lung and right ventricle in rats. METHODS: Wistar rats were divided into control group (Group A, n = 21) and hypercapnic group (Group B, n = 30). Group B received mixed gas exposure (8% CO(2), 21% O(2), 71% N(2)), 7 hours daily for 4 weeks. Arterial blood gas, superoxide dismutase (SOD), lipid peroxide (LPO) in the tissue of the lung and right ventricle were determined. Histopathological changes of the lung and right ventricle were investigated by light microscope, transmission and scanning electron microscope. RESULTS: Decompensated respiratory acidosis [pH 7.21 +/- 0.04, PaCO(2) (56 +/- 3) mm Hg] developed in Group B. SOD in the lung [(463 +/- 174) U/g protein] and ventricle tissue [(235 +/- 94) U/g protein] in Group B were significantly lower than those in Group A (P < 0.01), while LPOs [(8.1 +/- 3.2) nmol/ml and (17 +/- 5) nmol/ml] in group B were significantly higher than those in Group A (P < 0.01). The index of pulmonary capillary permeability in Group B (37 +/- 4) was also higher than that in Group A (28 +/- 4, P < 0.001). Tissue edema in the lung and heart, endothelial cell damage of the small blood vessels and severe myofibril damage of the right ventricle, pulmonary microthrombus formation and increased pulmonary capillary permeability were found in Group B. CONCLUSION: Hypercapnic rat model is successfully reproduced by exposure of 8% CO(2); high concentration of CO(2) causes severe damage of the lung and right ventricle as well as the whole body.

Animals↗
PubMed2002

[Postoperative management in single-lung transplantation for lymphangioleiomyomatosis].

A 35-yr-old woman presented with dyspnea has been diagnosed as having lymphangioleiomyomatosis (LAM). Despite treatment with estrogen, her pulmonary function deteriorated progressively. In January 2001, a left single-lung transplantation was performed on her from a cadaveric donor. On admission to the ICU after the transplantation, arterial blood gas analysis showed a severe respiratory acidosis. A double-lumen endotracheal tube (ETT) was replaced by a single-lumen ETT for a better suctioning of secretion. Gas exchange improved after the replacement of ETT and suctioning of secretion by bronchoscopy. Five hours after the admission to the ICU, the breath sound decreased over the right thorax. The chest X-ray showed right pneumothorax, and a chest tube was inserted. The patient was weaned from mechanical ventilation gradually and extubated on the 6th ICU day. The patient was discharged from ICU to the general ward on the 9th ICU day without pneumonia and other complications. The development of pneumothorax in the recipient lung should be kept in mind during the perioperative period of lung transplantation for LAM.

Adult↗
PubMed2002

[The epidemiology and clinical features of Legionella pneumonia (LP) in patients older than 60 years old who were hospitalized with pneumonia in northern Israel].

BACKGROUND: Risk factors associated with LP are frequent in patients older than 60 years old who are hospitalized with pneumonia. The aim of the study was to define the incidence, epidemiological and clinical features of LP in this age group in Northern Israel. STUDY DESIGN: The study was prospective and conducted for one year during the period 1.6.1999-31.5.2000. All patients older than 60 years who were hospitalized with community-acquired or nosocomial pneumonia were tested for legionella infection by the urine antigen test (which identifies Legionella pneumophila type I and 14 other Legionella serotype antigens). Data was obtained from each patient regarding risk factors and clinical feature of the disease. The data of patients with LP was compared on a 1:2 ratio to data obtained from a control group of patients with non LP according to age, sex, and week of admission. RESULTS: During the study period 202 patients and 38 patients were hospitalized with community-acquired or nosocomial pneumonia respectively. Overall, 8/240 patients (3.3%) were found to suffer from LP. All patients with LP had community-acquired pneumonia with an incidence of 8/202 (4%). Six of the 8 patients (75%) with LP were hospitalized during June-September. Significant clinical findings in patients with LP as compared to those in the control group, respectively, were: severity score, history of smoking, mental status alteration, respiration rate over 30/minute, respiratory acidosis, hypoxia, and need for mechanical ventilation (P < 0.05 in all). All patients with LP were treated with macrolides, however the death rate was 50% vs 0% in the control group (p < 0.001). CONCLUSIONS: In northern Israel, LP is infrequent among patients older than 60 years hospitalized with pneumonia. The disease occurs mostly during the summer in patients with community acquired pneumonia. Patients with LP had unique and more severe clinical features and the death rate was very high inspite of appropriate therapy.

Aged↗
PubMedDate not supplied

[Congenital posterolateral diaphragmatic hernia].

Eighty-four cases of posterolateral diaphragmatic hernia in children are reviewed. The most frequent signs were respiratory insufficiency, cyanosis and costal indrawing. The diagnosis was clinically established in over one half of the cases. In most of the patients, the studies showed respiratory acidosis. Also, radiological studies showed, in most of the cases, elevation of the hemidiaphragm with basal opacity of the hemithorax. For surgical treatment, the choice route was the abdominal. Overall mortality reached 37%.

Diagnosis, Differential↗
PubMed2002

[Acid-base state in rats with different resistance to hypoxia in experimental tracheal stenosis].

Rats with different resistance to hypoxic hypoxia differ in parameters of their acid-base state: in high resistance, lower values for blood pH are recordable together with slightly higher pCO2 and content of non-volatile acids. Development of experimental stenosis of trachea in low- and high-resistant animals has been shown to significantly disturb the acid-base state (particularly in low-resistant rats). This process is compensatory-adaptive; it is characterized by development of respiratory acidosis at day 1 to 3, with the indices tending to return to the normal range at day 7, mixed acidosis developing later on.

Acid-Base Equilibrium↗