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At least 1,423 records · Page 79Linked to original sources
PubMed1983

Cardiopulmonary effects of thiopental/lidocaine combination during anesthetic induction in the dog.

The cardiopulmonary effects and tendencies to produce ventricular arrhythmias were evaluated in 13 dogs given a surgical plane of anesthesia by thiopental (IV) or a combination of thiopental and lidocaine (IV). Thiopental (22 mg/kg of body weight) was compared with a combination of thiopental (11 mg/kg) and lidocaine (8.8 mg/kg). Preanesthetic agents were not given. Both methods for IV anesthesia provided a smooth induction suitable for easy intubation. The thiopental/lidocaine combination had a shorter duration, produced no arrhythmias, and resulted in less cardiopulmonary depression than did thiopental alone. Bigeminy developed after intubation during 19 of 20 thiopental inductions as compared with that in 0 of 22 thiopental/lidocaine inductions. The bigeminies were preceded by systemic hypertension and tachycardia which developed as the trachea was being intubated. The increase in aortic pressure and heart rate was minimal after intubation during the thiopental/lidocaine inductions. Five minutes after administration of thiopental alone, increases in heart rate, aortic pressure, total peripheral vascular resistance, and left ventricular systolic and end-diastolic pressures were observed. When these increases in rate, preload, and afterload were considered in relation to a stabile maximum positive first derivative of left ventricular pressure, left ventricular contractility was considered to be decreased. Mild respiratory acidosis and hypoxemia were present at 5 and 10 minutes after thiopental induction. Because the combination of thiopental/lidocaine had less cardiopulmonary depressive effects and protected against arrhythmias, it would appear to be a good method for anesthetic induction of the patient with cardiopulmonary disease. In the patient with normal cardiopulmonary function, thiopental produces only a moderate and reversible depression.

Anesthesia↗
PubMed1981

[3-years' domiciliary respirator therapy in idiopathic hypoventilation syndrome (ondine's curse syndrome) (author's transl)].

A 67 years old patient with a tracheostomy and cribral cannula on account of severe idiopathic hypoventilation syndrome was discharged from the intensive care unit having been supplied with a respirator (MK 8-Bird) and compressor by his health insurance. The domiciliary respirator therapy was continued for more than 3 years. The disorder manifested itself initially in severe hypoventilation during sleep, acute hypoxaemia, hypercapnia and respiratory acidosis. The patient himself and his family took on the adjustment and maintenance of the respirator, having being appropriately trained before his discharge from hospital. The treatment succeeded for over 3 years in maintaining an acceptable quality of life for the patient.

Aged↗
PubMed1982

[Effects of a partial exchange transfusion with Fluosol DA 20% on healthy pigs].

In 9 animals 500 ml of blood was replaced with 500 ml of Fluosol DA 20%. An average of 19.2 ml per kg body weight of emulsion, i.e. 3.883 gm per kg body weight of fluorocarbons was given. On the eighth day following exchange transfusion the animals were killed and tissue samples taken from liver and lung for electron microscopy and chemical analysis. Biochemical parameters were measured in central venous blood prior to transfusion and on the 2nd, 3rd, 6th and 8th days. One animal died on the sixth day of study, hence only the results obtained from the remaining 8 animals were analysed. On removing the lungs a marked firmness of consistency and failure to collapse was noted. Electron microscopy revealed numerous phagocytic cells packed with foam-like substance, partly occluding the pulmonary capillaries. On chemical analysis a residue of 23.95 mg fluorocarbon per gm of lung tissue was found. Acid-base analysis of central venous blood showed a compensated respiratory acidosis on the 6th and 8th day. The hepatic reticulo-endothelial system was found to be laden with numerous vacuoles, to such a degree that the sinusoids were all practically fully occluded. Neither cell necrosis nor inflammatory reactions were observed.

Acid-Base Equilibrium↗
PubMed1980

[Blood serum electrolyte content in pigs during general anesthesia induced by administration of chloral hydrate, nembutal, eunarcon and brevinarcon].

Sixty pigs were used for the study. The animals were divided into 5 groups, 12 pigs in each. The following substances were administered intravenously in the individual groups: I -- 20 ml of physiological solution NaCl (placebo, II -- chloral hydrate (10% solution), III -- Nembutal, IV -- Eunarcon, V -- Brevinarcon (10% solution). Blood was collected from the anterior vena cava after 1 hour and after 1, 3 and 7 days since the moment of administration of physiological saline (group I), or since the appearance of general anaesthesia (groups II-V). Determinations in blood serum concerned: Na, K and Ca -- with the use of a flame photometer, Mg -- by the method of Lange, Cl -- by the method of Schales and Schales, inorganic phosphorus -- by the Fiske-Subbarow method. The results were analysed statistically by determining the mean, the standard deviation and the significance of variations according to the t Student test (risk of error -- 5%). The results obtained in groups II-V were compared with the corresponding results from group I. It was found that chloral hydrate, Nembutal, Eunarcon and Brevinarcon, used to produce general anaesthesia in healthy pigs (not operated upon) produce a decrease in the sodium and potassium content, an increase in the magnesium and inorganic phosphorus content, and slight changes in the calcium and chlorine content. The greatest and most prolonged deviations were found after chloral hydrate and Nembutal the slightest after Brevinarcon. Eunarcon produced short-lived changes, but greater than after Brevinarcon. These changes in the level of electrolytes in serum should be attributed to disturbances of respiration (respiratory acidosis), and to decreased activity of muscles during anaesthesia in pigs.

Anesthesia, Intravenous↗
PubMed1981

[Comparison between ketamine, propanidid, and etomidate in general anaesthesia for caesarean section (author's transl)].

Propanidid, etomidate, and ketamine were compared for their effects on maternal acid-base balance and circulation as well as on postnatal general condition and acid-base balance of the newborn, on the basis of 44 women in advanced pregnancy to whom caesarean section was applied in general anaesthesia. The probands had not been deliberately selected beforehand. Results obtained from the three above anaesthetics were compared with one another as well as with parameters recorded from spontaneously delivered newborns without any medication. One of the anaesthetics produced sufficiently deep anaesthesia in all patients, and no signs of central depression were recordable from the newborns. The parameters of acid-base balance, following propanidid and etomidate anaesthesia, revealed respiratory acidosis in the newborns immediately after delivery by caesarean section. Their pH values were lower than those recorded in the context of ketamine anaesthesia or spontaneous delivery without any medication. Both values returned to normal within 30 minutes from delivery. The one-minute and five-minute Apgar scores were below those of spontaneous deliveries, at the beginning, but eventually reached normal levels. All the three anaesthetics were found to be suitable for introduction of general anaesthesia for caesarean section on account of high-rate enzymatic degradation and, consequently, absence of foetal depression. Resulting oxygen supply is higher, as compared to spontaneous delivery. Early indication and short-time introduction and delivery, thus possible, have often proved to be important to the newborn's condition.

Anesthesia, General↗
PubMed1981

Evaluation of the actions and use of alphaxolone/alphadolone (CT1341) in sheep.

CT1341 (alphaxolone/alphadolone) (Saffan; Glaxo) at various dose rates was investigated for use as an intravenous anaesthetic agent in sheep and it was found that at least 1.65 mg/kg was required to induce anaesthesia. In an experimental group of animals the effect of CT1341 2.2 mg/kg, on PaO2, PaCO2, paH and mean arterial blood pressure was measured. The drug caused a mild respiratory acidosis accompanied by a slight decrease in PaCO2 tensions. Mean arterial blood pressure decreased by 50 per cent, 30 seconds after injection but this fall lasted for only 10 minutes. Prior administration of either atropine sulphate or mepyramine maleate failed to modify this hypotensive effect. Injection of the vehicle, Cremophor EL, alone had no effect on mean arterial blood pressure. Intracerebroventricular administration of CT1341 while producing anaesthesia failed to produce any hypotension. The drug was used for the induction of anaesthesia in 19 sheep. A mean dose of 3.0 mg/kg was found to be most useful clinically. In a further three sheep an infusion of a dilute solution (0.234 mg/kg per minute) was used to maintain anaesthesia. The most notable clinical feature in sheep was the fast, complete recovery. It is concluded that this agent is an extremely useful drug for the induction and maintenance of anaesthesia in sheep.

Anesthesia, Intravenous↗
PubMed1980

[Mediastinal complications following retropleural operation for oesophageal atresias (author's transl)].

Serious acute complications can occur in relation to anastomotic insufficiency or re-opening of the fistula in patients with tracheo-oesophageal fistula and atresia, even if the repair has been carried out extra-pleurally. For this reason the patient should not be nursed flat and the important life-threatening signs to watch for are increasing tachypnoea and dyspnoea with respiratory acidosis and a central air shadow in the mediastinum.

Esophageal Atresia↗
PubMed1995

Comparison of anesthesia induced by ketamine-fentanyl combination and maintained by propofol or etomidate in New Zealand white rabbits.

Ketamine-fentanyl-propofol and ketamine-fentanyl-etomidate combinations were administered intravenously to four groups of rabbits. Each group received ketamine (30 mg/kg of body weight) and fentanyl (0.025 mg/kg) for anesthesia induction. Either propofol or etomidate was administered by an infusion pump to maintain anesthesia. The rabbit's responses to noxious stimuli were determined before anesthesia was induced and at 10-min intervals thereafter until the rabbit recovered. The effects of the anesthetic combinations on the cardiopulmonary system were measured by monitoring respiratory and heart rates, blood pressure, and arterial blood gas tensions. Etomidate infused at the rate of 0.2 or 0.1 mg/kg/min could maintain surgical anesthesia with fewer effects on the cardiopulmonary system for 40 and 30 min respectively. However, the high mortality and side effects such as hemolysis in these two groups preclude the clinical use of etomidate for anesthesia maintenance. Propofol administered intravenously at rates of 0.8 and 0.4 mg/kg/min could maintain surgical anesthesia for 40 and 30 min respectively. However, relatively severe hypotension, hypercapnia, and respiratory acidosis were associated with this drug. Recovery from the propofol infusion was very rapid. Ketamine-fentanyl-etomidate combination is not recommended for clinical anesthesia in rabbits. Ketamine-fentanyl-propofol combination at a dosage of 30-0.025-0.4 mg/kg/min can be safely used for short-term surgery.

Anesthesia, Intravenous↗
PubMed1995

[Blood gas changes in Duchenne type muscular dystrophy].

We studied changes in blood gas data from 32 patients with Duchenne type muscular dystrophy (DMD), who were followed for more than 5 years. Regression lines for each blood gas variable were obtained by the least square regression method, from 276 observations. The mean change per year was calculated by averaging the individual slopes. All blood gas variables (PaO2, PaCO2, pH, and [HCO3-]) correlated significantly with age the regression lines were: PaO2 = 95.6-0.45x Age, PaCO2 = 34.7 + 0.70x Age, pH = 7.397-0.0023x Age, [HCO3-] = 20.7 + 0.28x Age. The rates of change were -0.74 Torr/year for PaO2, 1.07 Torr/year for PaCO2, -0.0028 per year for pH and 0.55 mEq/l/year for [HCO3-]. The slope of each regression line was within the average individual yearly change +/- one standard deviation. AaDO2 did not change significantly with age, but chronic respiratory acidosis worsened because of alveolar hypoventilation. As an index of the severity of DMD, PaCO2 was better than PaO2, because the former was more strongly correlated with age and the values of PaCO2 deviated less from the the regression line.

Adolescent↗
PubMed1975

[The rat ventricular myocardium in chronic hypercapnia. Electron microscopic study].

An electron microscope study of the left ventricular myocardium from rat acclimatized to chronic hypercapnia was done in order to complete the preceding work concerning general effects of respiratory acidosis. After 15 and 30 days of the acclimatation to 8% CO2 no lesions of the myocardium could be found. The results of the morphometric analysis indicated, however, discrete modifications of heart ultrastructure similar to those found before in hypoxic and failing hearts: namely a decrease of mitochondrial mean diameter and a non significant decrease of mitochondrial fractional volume. The latter was accompanied by a significant decrease of myofibrillar mass. The presence of cellular oedema seems to be suggested by an increase of fractional volume of the cytosol. The mechanism of these changes is not easy to explain. Further work will be necessary to make a choice between two possibilities: (1) depressed contractility related to some direct effect of high pCO2 and (2) tissue hypoxia secondary to local effects of the former.

Animals↗
PubMed1995

[Endotracheal intubation and mechanical ventilation in severe asthma].

Retrospective analysis of all patients with acute bronchial asthma who required intubation and mechanical ventilation was performed in 1987-1993. Our study group comprised 29 patients with a total of 31 episodes of mechanical ventilation. Indications for intubation and ventilation were cardio-respiratory arrest in 9 episodes, and deterioration of clinical status despite aggressive therapy in 22 episodes. Mechanical ventilation strategy was to avoid high air-way pressures of more than 50 cm H2O even if respiratory acidosis persisted. The risk of barotrauma was thus eliminated; other complications were few and reversible, and all patients survived. We conclude that intubation and mechanical ventilation in severe asthma is beneficial and safe, and the prognosis very good.

Asthma↗
PubMed1995

[Sequential neuroimaging in a patient with delayed post-hypoxic leukoencephalopathy].

We described a patient with delayed cerebral demyelination following a post-operatively hypoxic encephalopathy. A 65-year-old man, with a history of exposure to the atomic bomb at Hiroshima in 1945, suffered from hypoxia, hypotension and respiratory acidosis and became unresponsive 10 hours after a laminectomy for lumbar disc herniation, in December 1993. Following an emergent resuscitation, the patient had gradually recovered and could walk 2 weeks later. Three weeks after the insult, however, the patient developed an apallic state with frontal lobe signs. Except an increased level of myelin basic protein in the CSF, there were no other abnormal laboratory findings. Brain CTs showed a leukoaraiosis. MRI one month post-operation, demonstrated extensive high signal intensity areas in the cerebral white matter on T2-weighted image, and a gadolinium-enhanced spotty lesion in the right globus pallidus on T1-weighted image. Three months after the operation, the high signal intensity on T2-weighted image became more intensive and extensive, while the enhanced spotty lesion in the globus pallidus disappeared. The corpus callosum and cerebellar white matter were spared throughout the observation. The SPECT using 123I-IMP showed a hypoperfusion in the frontal lobe at 1 month. Three months later, the hypoperfusion areas extended to the whole cerebral and cerebellar cortices, relatively less affected in the motor area and basal ganglia. The patient had improved slightly over the next few months. We speculate that subclinical vulnerability in the white matter secondary to exposure to the atomic bomb, in addition to the incomplete prolonged hypoxia, hypotension and acidosis, caused selective cerebral demyelination in this patient.

Aged↗
PubMed1994

The duration of the second stage of labour.

Fetal outcomes following extended second-stage labour include respiratory acidosis, lower umbilical vein and artery pH, lactacidaemia and early neonatal seizures. Maternal outcomes following extended second-stage labour include postpartum haemorrhage, puerperal fever, backache, musculoskeletal problems, stress incontinence and denervation of the pelvic floor. It is suggested that intervention should be based on the use of judgement and skill rather than strict adherence to timetables.

Female↗
PubMed1994

[The influence of natural peat and isolated humic acid solution on certain indices of metabolism and of acid-base equilibrium in experimental animals].

The biological effect in rats treated with natural peat homogenate and isolated humic acids has been shown in pharmacodynamic studies. After 24 days of this treatment decrease of total cholesterol, total lipids, an increase of HDL fraction of cholesterol, decrease in glucose level and increase of protein fraction of globulin, hemoglobin, hematocrit and total number of erythrocytes were observed. The treatment did not influence the electrolyte equilibrium. However, after the treatment with humic cides the respiratory acidosis not compensated with the metabolic component was observed. The activity of the natural peat was more favorable as compared to the activity of humic acids solution.

Acid-Base Equilibrium↗
PubMed1994

Pulmonary histopathologic findings, acid-base status, and absorption of colostral immunoglobulins in newborn calves.

A study was conducted to investigate whether aspiration of amniotic fluid is associated with a deleterious effect on absorption of colostral immunoglobulins or on blood gas and acid-base values of healthy newborn calves. Fourteen calves purchased from commercial sources were transported to a research facility immediately after birth and fed colostrum with known concentrations of immunoglobulins. Blood samples for gas analyses were collected within 5 hours of birth, 24 hours later, and prior to euthanasia. Between 3 and 5 days of age, calves were euthanatized by an overdose of barbiturates. Eleven calves had evidence of bronchoaspiration of amniotic fluid, as determined by presence of meconium, squamous epithelium, or keratin in histologic sections of fixed lung or by cytologic analysis of bronchoalveolar lavage fluid. Blood gas tensions and pH were within reference ranges in 11 of 14 calves. Aspiration of amniotic fluid could not be linked to any specific changes in blood gas tensions, acid-base status, or absorption of colostral immunoglobulins. Presence of keratin and meconium in the lungs often was accompanied by mild exudative alveolitis and focal atelectasis. It was concluded that aspiration of small amounts of amniotic fluid with or without meconium is common in calves and is not associated with hypoxemia, respiratory acidosis, or failure of passive transfer.

Acid-Base Equilibrium↗
PubMed1994

[Pathophysiological study of asphyxia and its applications to medico-legal diagnosis].

Asphyxia is commonly defined as "a hypoxic state in the body" which is caused by any one of a wide range of events, starting from an insufficiency of atmospheric oxygen to a failure in oxygen uptake by the cells. The present study outlines a physiopathological study of "mechanical asphyxia" various types of hypoxia caused by mechanical compression of the cervical and thoracic regions and its application to medicolegal diagnosis. We used an animal model in which an actual asphyctic condition was experimentally recreated. By elaborating the asphyctic mechanism through the physiological dynamics of the body fluids and tissues during the fatal process and the succeeding short time span, the study was intended to estimate the causes of death, time lapse after death before the examination, and the time of death in persons who were subjected to investigation, autopsy, or forensic examination. Our intention was also to establish medicolegal indices for the cause of death by examining patients who were resuscitated or expired before arrival (DOA). Our past superimental findings indicate that asphyxia is a state in which arterial blood gas anomalies (hypoxemia and hypercapnia) develop due to a disturbance in the respiratory mechanism, disrupting the maintenance of normal bodily functions by the organism. Among the clinical conditions of respiratory insufficiencies, asphyxia caused by external mechanical, factors (such as external application of pressure to the naso-oral, cervical, or thoracic region, insertion of a foreign body into the airway, and aspiration of fluids) corresponds to acute respiratory insufficiency due to hypercapnia type. In most of these cases with mechanical asphyxia, ventilatory insufficiency due to a lack of O2 in the inhaled air and insufficient removal of CO2 through expiration causes pulmonary alveolar hypoventilation and hyperemia associated with hypercapnia. Consequently, hypoxic hypoxia with systemic disturbances develops. The rapidity of development of the clinical events is correlated with the velocity of the rise in blood CO2 level and the development of acidemia from the early stage. The conditions culminate in non-compensatory (acute) respiratory acidosis. These abnormal physiological changes in turn produce symptoms such as congestion and cyanotic petechia. Asphyxia ensues if no resuscitation or other medical treatment is available during this stage (the so-called early asphctic stage). We believe that an understanding of these physiopathologic changes is useful in the diagnoses of asphyxia. It is also useful in the diagnosis of the above-cited process in cases of DOA and in patients who have received resuscitation or other medical treatment.

Animals↗
PubMed1994

Probable succinylcholine-induced hyperkalemia in a trauma victim after recent benign anesthetics with succinylcholine.

Throughout its pharmacological history in anesthesia practice, succinylcholine has been notorious for its role in causing life-threatening hyperkalemia. Normally the serum potassium level will increase .5 to 1.0 mEq/L because of a sustained opening of the receptors in the neuromuscular junction and release of myoplasmic potassium. However, in certain patients the drug will result in a much higher level of serum potassium. The literature points out numerous conditions that predispose particular patients to this exaggerated intensification of potassium leakage from within the cell. Traumatized, neuromuscular diseased, infected, exsanguinated, acidotic, and closed head injury patients among this list. This case report describes a trauma patient requiring numerous orthopedic repairs in a relatively short period of time. He received succinylcholine on three separate occasions within a 20-day span without any untoward effects. However, during his sixth surgery and the fourth administration of succinylcholine, he developed ventricular fibrillation requiring defibrillation and cardiopulmonary resuscitation before converting to a sinus tachycardia. After ruling out other causes of the arrhythmia, the most probable one was hyperkalemia. A possible explanation of this probable succinylcholine-induced hyperkalemia may have been a combination of the trauma, tissue wasting, infection, immobility, or acute respiratory acidosis. The potassium elevation was treated successfully with hyperventilation, calcium chloride, sodium bicarbonate, glucose, and insulin. The patient recovered without complications and was later discharged to home. Succinylcholine definitely has its use in anesthesia, but it is imperative for the provider to be discriminatory in its administration. An all-encompassing history is paramount to discover any hidden rationale not to use succinylcholine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Experimental model of single ventricle. Influence of carbon dioxide on pulmonary vascular dynamics.

BACKGROUND: Important in the postoperative management of neonates with single-ventricle complexes, such as hypoplastic left heart syndrome and pulmonary atresia with intact ventricular septum, is the fact that the pulmonary circulation is connected to the systemic circulation via a shunt. The distribution of flow to the pulmonary and systemic vascular beds depends directly on the pulmonary-to-systemic vascular resistance ratio. Changes in this ratio result in alterations in flow that have an impact on survival. METHODS AND RESULTS: PICO2 has a potent effect on pulmonary vascular resistance. In this study, the addition of CO2 to inspired gas (PICO2) is assessed as a means of modulating the ratio of pulmonary-to-systemic vascular resistance and thus flow, while avoiding the consequences of hypoventilation. Thirteen neonatal piglets (age, 17 to 30 days) were subjected to atrial septectomy, patch closure of the tricuspid valve, and creation of a 4-mm systemic-to-pulmonary arterial shunt to mimic the physiology of single-ventricle complexes. Pulmonary and systemic flows; aortic, pulmonary artery, and atrial pressures; and arterial blood gases were measured with the addition of different levels of CO2 to the inspired gases (PICO2 = 0 to 35 mmHg). In all animals, pulmonary vascular resistance (PVR) increased in direct correlation with PICO2. In group 1 (n = 8), PVR increased in direct correlation with PICO2 and PACO2, and inversely with respect to pH (r = .98, .74, and .83, respectively). Group 2 animals (n = 5) received infusions of Tham to buffer hydrogen ion and compensate for respiratory acidosis. PVR again increased in direct correlation with FICO2 (r = .97). In both groups, systemic vascular resistance (SVR) was less directly influenced by FICO2 (r = .53). CONCLUSIONS: CO2 exerts a vasoactive influence on pulmonary vasculature that is largely independent of SVR and pH. Regulating PICO2 is an effective means of achieving a favorable ratio of pulmonary-to-systemic vascular resistance and thus flow in the fragile physiology encountered in neonates with single-ventricle complexes.

Animals↗