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PubMed1991

[Lipomatous hypertrophy of the atrial septum. Cardiac-induced syncope in hamartoma of the right heart atrium].

A previously well 40-year-old woman suddenly collapsed and had to be resuscitated by an emergency physician. Admitted to hospital she remained unconscious and needed artificial respiration. Diagnostic tests failed to find evidence for pulmonary embolism, myocardial infarction or myocarditis. ECG monitoring in the intensive care unit merely revealed occasional unifocal ventricular premature systoles. Echocardiography was within normal limits. She remained in coma without spontaneous respiration. Cranial computed tomography and serial electroencephalograms indicated brain death. Autopsy revealed lipomatous hypertrophy (hamartoma) of the atrial septum with extensive bleeding into it as the most likely cause of (unrecorded) malignant cardiac arrhythmias.

Adult↗
PubMed1999

Anesthetic considerations in pediatric laparoscopic and thoracoscopic surgery.

Minimally-invasive surgery does not equate with minimally-invasive anesthesia in children undergoing laparoscopic and thoracoscopic surgery. Knowledge of the associated pathophysiological changes, appropriate monitoring and good planning allow the safe provision of anesthesia for children subjected to these otherwise advantageous surgical techniques.

Adult↗
PubMed1988

Using the Heimlich maneuver to save near-drowning victims.

Flooding of the lungs occurs routinely in drowning victims. The cause of death in 90% of them is hypoxemia caused by water in the lungs. Mouth-to-mouth ventilation is ineffective until the water is removed. The Heimlich maneuver expels aspirated water, vomitus, debris, and other foreign matter. In treating near-drowning victims, place the victim in the supine position with head turned to the side and perform the Heimlich maneuver to evacuate water from the lungs, unless you know water is not in the respiratory tract. The Heimlich maneuver is a form of artificial respiration. It elevates the diaphragm, increasing intrathoracic pressure and compressing the lungs, and should be performed intermittently until all water is expelled. It is an especially useful technique because fear of contagion sometimes deters rescuers from using mouth-to-mouth ventilation . Further treatment has not been necessary in most instances. If the victim does not recover after water ceases to flow from the mouth, ventilation techniques, cardiopulmonary resuscitation, and other measures as indicated should be used.

Adult↗
PubMedDate not supplied

Alternative cardiopulmonary resuscitation devices.

Cardiopulmonary resuscitation (CPR) involving manual external chest compression combined with artificial respiration was first described in 1960 by Kouwenhoven et al. (Kouwenhoven W, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA. 1960; 173:1064-7). In the four decades since then, there have been no widely accepted alternatives for this technique. Even with the subsequent worldwide adoption of CPR and other advanced cardiac life support measures, long-term survival after prehospital cardiac arrest is still typically only 5%, to 10%. The performance of CPR must therefore be improved to increase the rate of long-term survival. Currently under development are new, alternative techniques such as interposed abdominal compression (IAC), active compression-decompression (ACD), pneumatic and nonpneumatic circumferential chest compression, and minimally invasive cardiac massage. Many of these newer techniques, compared with standard manual CPR, appear to provide superior vital organ blood flow and increased blood pressure. To date, only IAC (in-hospital only) and ACD have been shown to improve long-term survival in clinical studies. Circumferential chest compression and minimally invasive cardiac massage, on the other hand, have not yet been adequately tested in large clinical trials. Despite the difficulty and expense in studying these CPR techniques, additional research is necessary to evaluate their effectiveness in improving survival after sudden cardiac arrest.

Advanced Cardiac Life Support↗
PubMed2006

Monitoring of verapamil enantiomers concentration in overdose.

A 52-year-old woman with a history of depression and personality disorders, hypertension, coronary disease and asthma was admitted to the Department of Clinical Toxicology after taking 60 tablets of Staveran (immediate release verapamil), and 4 tablets of acetaminophen. One and a half hours after ingestion her condition was critical. She required endotracheal intubation and artificial respiration. Her heart rate was 75 beats per minute, (bpm) and her blood pressure dropped from 70/50 to 50/00 mmHg. Additionally, drowsiness and headache were observed. On admission, R-(+)- and S-(-)-verapamil serum concentrations were 2252 ng/ml and 810 ng/ ml, respectively. Monitoring of the verapamil serum concentration was carried out over 74 h. Terminal elimination half-lives were 18.7 (21.3) and 17.0 (18.5) hours, respectively, for R-(+)- and S-(-)-verapamil. Monitoring of verapamil enantiomers concentrations in serum indicated a higher concentration of the less active form and slightly faster elimination of the more active enantiomer. The data-support a stereoselective difference between first pass clearance and later systemic clearance of verapamil, when taken in overdose.

Blood Pressure↗
PubMed2006

Experimental analysis of pendelluft flow generated by HFOV in a human airway model.

HFOV (High frequency oscillatory ventilation) is an effective artificial respiration technique for the treatment of pulmonary disease patients. In HFOV, the pendelluft is one of the important factors in gas transport and mixing mechanisms. Experimental analysis of the pendelluft flow generated in a bronchial tube model of single bifurcation with different volume ratios of daughter branches has been carried out by using time-resolved micro-particle image velocimetry obtaining instantaneous velocity distributions of oscillatory flows in the bronchial tube model at a frequency range of 10-15 Hz. Based on the oscillatory velocity profiles changing with time for different frequencies, the pendelluft phenomena have been discussed.

Bronchi↗
PubMed2005

Overdoses and ingestions of second-generation antipsychotics in children and adolescents.

OBJECTIVE: We reviewed the available published data on intentional or unintentional secondgeneration antipsychotic overdoses in children and adolescents. The prescribing of secondgeneration antipsychotics has continued to increase over the past decade for children, adolescents, and adults. The authors reviewed the existing literature to determine the circumstances, presenting problems, treatment, and outcomes of youths who were exposed to nontherapeutic doses of these medications. METHODS: A systematic English-language Medline search of all reports (1989-2005) and a review of the bibliographies of all articles obtained was done to identify papers reporting an overdose or ingestion of a second-generation antipsychotic. Data were reviewed on clozapine, risperidone, olanzapine, ziprasidone, quetiapine, and aripiprazole. The annual reports of the American Association of Poison Control Centers National Data Collection System were reviewed from 1990 to 2003, the most recent report currently available. All fatalities in children and youths under 18 years of age were included. RESULTS: The literature review identified 40 reports that included 63 patients, ranging in age from 1 day to 17 years of age. The clinical presentations included drowsiness, lethargy, agitation, irritability, combativeness, and tachycardia. There were 11 fatalities in the cases reviewed, 1 from clozapine overdose, 3 from risperidone overdose, 2 from olanzapine overdose, and 5 from quetiapine overdose. All other cases reported no significant sequelae and resolved without any reported clinical consequences. Duration of overdose symptoms ranged from 24 hours to 7 days. One case of clozapine intoxication showed resolution of symptoms in 6 hours and, in another case of olanzapine overdose, symptoms resolved in 13 days. The most frequently employed treatments included intubation, gastric lavage, activated charcoal, intravenous fluids, artificial respiration, and restraints or sedatives. CONCLUSIONS: There is a need for future case reports to include serum medication level, weight of patient, coingestants, the health of the patient at baseline, relevant laboratory and toxicology studies and a standardized scale to rate the level of consciousness, such as the Glasgow Coma Scale. The existing pharmacovigilance data reports indicate these medications are relatively safe when taken in overdose, particularly when coingestants are not involved.

Adolescent↗
PubMed2006

Triiodothyronine acutely increases blood flow in the ventricles and kidneys of anesthesized rabbits.

Thyroid hormone (triiodothyronine [T(3)]) has various nongenomic effects, including alterations in glucose and fatty acid metabolism, augmentation of intracellular Ca(2+), enhancement of myocardial contractility, and vascular dilatation. However, its effect on regional blood flow remains to be established. We have measured the effect of T(3) on blood flow in major organs of anesthetized rabbits in vivo using the microsphere method. Under artificial respiration, nonradioactive microspheres (5 x 10(5)) labeled with barium were injected to measure blood flow at control level. Then, T(3) (50 microg/kg per milliliter) was administered and microspheres labeled with iodine (5 x 10(5)) were injected. The atria, ventricles, kidneys, and right upper limb were excised and their contents of microspheres were evaluated. Blood flow in the ventricles was significantly increased by T(3) (2.9 +/- 0.3 versus 3.4 +/- 0.3 mL/min per gram, vehicle versus T(3)). Similarly, blood flow in the kidneys was significantly higher after T(3) injection (4.3 +/- 0.5 versus 5.1 +/- 0.5 mL/min per, vehicle versus T(3)). The blood flow in the atria and skeletal muscles remained unchanged. These results indicate that the vasodilatory response to T(3) is not uniform and occurs preferentially in major organs such as cardiac ventricles and kidneys; this may be relevant to the T(3)-induced improvement of cardiac function.

Anesthesia↗
PubMed1981

Effects of hypoxia on myocardial digoxin uptake and levels of plasma catecholamines in anaesthetised dogs.

The effect of hypoxia on digoxin pharmacokinetics, myocardial digoxin uptake and levels of plasma catecholamines in dogs was studied to clarify the mechanism of enhanced sensitivity to digitalis in hypoxia. Sixteen mongrel dogs were anaesthetised and artificially respired; eight with room air, eight with 8% oxygen in nitrogen, and digoxin (0.05 mg . kg-1) was intravenously given to each dog. There was no difference between hypoxic and non-hypoxic dogs in pharmacokinetic curves of digoxin. The level of myocardial digoxin in hypoxic dogs was significantly lower than that in non-hypoxic dogs. The level of plasma adrenaline in hypoxic dogs was significantly higher than that in non-hypoxic dogs (P less than 0.01). These data suggest that enhanced sensitivity to digoxin in hypoxia may be attributable not to abnormal digoxin pharmacokinetics or increased myocardial digoxin uptake but partly to higher levels of plasma catecholamines.

Animals↗
PubMed1993

Combined effect of the 5-HT2 receptor antagonist DV-7028 and aspirin or heparin on coronary cyclic flow reductions in dogs.

OBJECTIVE: The aim was to study the combined effect of DV-7028, a selective 5-hydroxytryptamine2 receptor antagonist, and aspirin or heparin on cyclic flow reductions in the canine coronary artery. METHODS: Anaesthetised open chest beagle dogs under artificial respiration were used. Cyclic flow reductions were induced by partial occlusion of the left anterior descending coronary artery at the site of endothelial injury. After induction of cyclic flow reductions, test drugs were given to the animals intravenously. RESULTS: DV-7028 (0.1 mg.kg-1) reduced the frequency of cyclic flow reductions by 77% and improved the nadir of coronary blood flow velocity that indicated the severity of cyclic flow reductions. Also, aspirin (1 or 3 mg.kg-1) or heparin (200 U.kg-1) attenuated the cyclic flow reductions. In experiments with drug combinations, DV-7028 was given to animals that had already received aspirin (1 mg.kg-1) or heparin (200 U.kg-1). DV-7028 (0.1 mg.kg-1) completely abolished the cyclic flow reductions remaining after aspirin treatment in three of four animals. Heparin inhibited the cyclic flow reductions in one of five animals and the addition of DV-7028 abolished the remaining cyclic flow reductions in the other four animals. After combined injection of DV-7028 with aspirin or heparin, the coronary blood flow with cyclical reductions returned to the baseline. CONCLUSIONS: The 5-HT2 receptor antagonist DV-7028 can inhibit the cyclic flow reductions that are resistant to aspirin or heparin. The combined regimen of DV-7028 and aspirin or heparin in treatment of acute coronary stenosis is more effective than that of aspirin or heparin alone.

Animals↗
PubMed2002

Segmental wall motion abnormalities during telerobotic totally endoscopic coronary artery bypass grafting.

UNLABELLED: In addition to single-lung ventilation (SLV), intrathoracic CO2 insufflation is mandatory for adequate exposure during totally endoscopic coronary artery bypass grafting. With transesophageal echocardiography, we investigated biventricular myocardial wall motion in 25 patients with isolated disease of the left anterior descending coronary artery who underwent totally endoscopic coronary artery bypass grafting with the "Da Vinci" robotic surgical system. At distinct time points during the operation, a cine loop of both ventricles was registered from a transgastric mid-short-axis view. Myocardial wall motion analysis was performed according to an established segmentation model of the left ventricle and to an established five-point scale for wall motion (1, normal; 5, dyskinesia). Significant alterations from preoperative baseline wall motion were visible in the septal, inferior, and anterior segments of the left ventricle at some time during the prebypass period, combined with a markedly decreased PaO2 under SLV and increased intrathoracic pressure. The same findings applied to the right ventricle; however, wall motion abnormalities were more pronounced here. After myocardial revascularization, weaning from cardiopulmonary bypass, CO2 deflation, and return to double-lung ventilation, myocardial wall motion recovered to baseline values. Clinically significant hemodynamic instability did not occur. The data suggest that robot-assisted coronary artery bypass grafting leads to significant prebypass alterations of biventricular segmental wall motion. On the basis of our data, it cannot be definitively stated whether the observed results were due to reduced oxygenation during SLV and thus "real" myocardial ischemia, intrathoracic CO2 insufflation with positive pressure leading to mechanical compromise of the heart, absolute or relative hypovolemia, or a combination of these factors. However, in this cohort, which consisted of patients with single-vessel disease and good ventricular function, these changes were of limited clinical relevance. IMPLICATIONS: Segmental myocardial wall motion was evaluated with transesophageal echocardiography during robot-assisted totally endoscopic coronary artery bypass grafting. Significant biventricular segmental wall motion abnormalities occurred before cardiopulmonary bypass under single-lung ventilation and carbon dioxide insufflation. The changes in myocardial wall motion were of limited clinical relevance.

Carbon Dioxide↗
PubMed1992

Effect of dietary sunflower seed oil on the severity of reperfusion-induced arrhythmias in anesthetized rats.

Myocardial ischemia followed by reperfusion was produced in artificially respirated, open-chest rats. Coronary artery ligation for 6 min rarely evoked arrhythmias; however, reperfusion after this period rapidly produced severe dysrhythmias in all control animals. Reperfusion after 12 min of ischemia produced less frequent dysrhythmias than after coronary occlusion for 6 min. Feeding of a linoleic acid-rich diet, applying 12% sunflower seed oil in rat food pellet for 4 weeks, decreased the incidence of reperfusion-induced ventricular fibrillation both after 6 min (2/15 vs. 7/11) and 12 min (0/11 vs. 2/8) of myocardial ischemia and the incidence of other arrhythmias was also decreased. The number of animals developing no arrhythmias during reperfusion was increased (8/15 after 6 min of ischemia, 4/11 after 12 min of ischemia vs. 0/11 and 0/8 in controls, respectively). Our results indicate that increased dietary consumption of linoleic acid decreased the occurrence of life-threatening arrhythmias both during the acute phase of myocardial ischemia and during reperfusion in anesthetized rats.

Anesthesia↗
PubMed1975

Possible adverse effects from local anesthetics and the treatment of these reactions.

Adverse drug reactions are potentially serious and are becoming increasingly common. Although optometrists employ only a limited spectrum of drugs they may encounter such reactions among their patients. There is always a risk that a life threatening situation will develop in a pateint quite apart from the use of any drugs. An optometrist as a member of the health-care team must be competent to provide first-aid if an emergency occurs. Tables are provided listing possible reactions to topical anesthetics with the usual signs and the preferred treatment. Optometrists are reminded that many of these treatments are the responsibility of physicians. Optometrists should be prepared to provide artificial respiration and external cardiac massage and should plan in advance how they will obtain additional assistance if an emergency occurs in their office.

Affective Symptoms↗
PubMed2001

Posterior atlanto-occipital dislocation and concomitant discoligamentous C3-C4 instability with survival.

STUDY DESIGN: A case report is presented. OBJECTIVES: To describe the diagnostic procedure, treatment, and outcome of a 56-year-old man with posterior atlanto-occipital dislocation and concomitant discoligamentous C3-C4 instability. CASE REPORT: A 56-year-old male seat-belted driver of a car was involved in an accident. After initial spontaneous breathing and weak movements of all his extremities, artificial respiration became necessary because of increasing respiratory insufficiency. Radiologic diagnostics, including computed tomography scans, showed a posterior atlanto-occipital dislocation and a Grade 2 craniocerebral trauma with occipital subarachnoidal bleeding. Further examination showed a serial rib fracture with concomitant hemopneumothorax. After stabilization of the patient, magnetic resonance imaging of the cervical spine showed a contusion of the upper cervical spinal cord. Additionally, rupture of the interspinal ligaments and the posterior longitudinal ligament could be seen, as well as a rupture of the intervertebral C3-C4 disc. Operative stabilization was performed by posterior fusion of C0-C4 using the CerviFix-System and autogenous bone grafts taken from the iliac crest. At 12 months after the operation, the patient had only slight weakness of the left arm and a 70% limitation in the range of motion of the cervical spine. CONCLUSIONS: With improvements in advanced trauma life support, the number of patients with atlanto-occipital dislocation admitted to hospital alive is increasing, so this particular lesion must be kept in mind. When the patient survives the accident, the long-term prognosis is quite good, with a high rate of recovery after initial neurologic deficits.

Accidents, Traffic↗
PubMed1990

Monitoring of nitrous oxide in operating rooms: identification of sources and estimation of occupational exposure.

In an academic hospital, nitrous oxide (N2O) levels were measured continuously and detailed workplace observations made in three different operating rooms for 18 days. The study was designed to determine the exposure of different categories of staff to nitrous oxide, to localize and quantify the emissions, and to predict and validate the effect of corrective measures. Nitrous oxide levels appeared to be highly time and place dependent; all staff, except for surgeons, were exposed to N2O levels (8-hour time-weighted average) above 25 parts per million. The most important contributor to total release of N2O was the ventilator (about 70%), especially during artificial respiration of the patient. A simulation model was developed and used to predict the effect of technical improvement of the ventilators and use of scavenging during anesthesia (total 58% reduction of release). The model shows that under these conditions, without altering room ventilation rates, room air circulation can be increased up to 50% without exceeding the proposed threshold limit value (25 parts per million). Measurement of N2O levels after intervention showed a reduction in the area surrounding the ventilator of about 80%, thereby reducing occupational exposure of all staff to below 18 parts per million.

Air Pollutants, Occupational↗
PubMedDate not supplied

Myxoedema coma.

Myxoedema coma is a medical emergency, which must be treated immediately. Otherwise the mortality is high. It is important to administer L-triiodothyronine and corticosteroids early. If hypoventilation occurs, artificial respiration may be necessary. In the two cases of described here the outcome was successful, probably owing to quick substitution. The causes of myxoedema and the symptomatology are discussed.

Adult↗