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Sample records for spontaneously breathing anaesthetized

  1. The Lack, Magill and Bain anaesthetic breathing systems: a direct comparison in spontaneously-breathing anaesthetized adults.

    OpenAIRE

    Humphrey, D

    1982-01-01

    The performances of the Lack (Mapleson A), Magill (Mapleson A) and Bain (Mapleson D) anaesthetic breathing systems were compared in each of 20 anaesthetized adult patients breathing spontaneously with fresh gas flows of 70 ml kg-1 min-1. In every patient the Lack system caused the least rebreathing, as seen by the lowest inspired and end-expired CO2 tensions using capnography. The Magill caused more rebreathing than the Lack though less than the Bain. Comparative fresh gas flows for each syst...

  2. The Lack, Magill and Bain anaesthetic breathing systems: a direct comparison in spontaneously-breathing anaesthetized adults.

    Science.gov (United States)

    Humphrey, D

    1982-01-01

    The performances of the Lack (Mapleson A), Magill (Mapleson A) and Bain (Mapleson D) anaesthetic breathing systems were compared in each of 20 anaesthetized adult patients breathing spontaneously with fresh gas flows of 70 ml kg-1 min-1. In every patient the Lack system caused the least rebreathing, as seen by the lowest inspired and end-expired CO2 tensions using capnography. The Magill caused more rebreathing than the Lack though less than the Bain. Comparative fresh gas flows for each system at the point where rebreathing started to occur were examined in 10 further patients. The Lack system required approximately 51 ml kg-1 min-1, the Magill 72 ml kg-1 min-1 while the Bain required 153 ml kg-1 min-1. Of the three systems the Lack is concluded to be the most efficient and economical system for spontaneous respiration in adults, with the additional advantages of convenient access to the exhaust valve, easy scavenging and low expiratory resistance. In addition, it also offers many useful advantages over the circle absorber system. Images Figure 1. PMID:6806473

  3. Airway management in spontaneously breathing anaesthetized children: comparison of the Laryngeal Mask Airway with the cuffed oropharyngeal airway.

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    Mamaya, Biruta

    2002-06-01

    The efficacy and safety of the smallest size of the cuffed oropharyngeal airway (COPA) for school age, spontaneously breathing children was investigated and compared with the Laryngeal Mask Airway (LMA). Seventy children of school age (7-16 years) were divided into two groups: the COPA (n=35) and the LMA (n=35). Induction was with propofol i.v. or halothane, nitrous oxide, oxygen and fentanyl. After depression of laryngopharyngeal reflexes, a COPA size 8 cm or an LMA was inserted. Ventilation was manually assisted until spontaneous breathing was established. For maintenance, propofol i.v. and fentanyl or halothane with nitrous oxide were used. Local anaesthesia or peripheral blocks were also used. Both extratracheal airways had a highly successful insertion rate, but more positional manoeuvres to achieve a satisfactory airway were required with the COPA, 28.6% versus LMA 2.9%. The need to change the method of airway management was higher (8.6%) in the COPA group. After induction, the need for assisted ventilation was higher in the LMA group 54.3% versus 20% in the COPA group. Airway reaction to cuff inflation was higher in the LMA group 14.3% versus COPA 5.7%. Problems during surgery were similar, except continuous chin support to establish an effective airway was more frequent (11.4%) in the COPA group. In the postoperative period, blood on the device and incidence of sore throat were detected less in the COPA group. The COPA is a good extratracheal airway that provides new possibilities for airway management in school age children with an adequate and well sealed airway, during spontaneous breathing or during short-term assisted manual ventilation.

  4. Comparison of work of breathing using drawover and continuous flow anaesthetic breathing systems in children.

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    Bell, G T; McEwen, J P J; Beaton, S J; Young, D

    2007-04-01

    We compared the work of breathing under general anaesthesia in children using drawover and continuous flow anaesthetic systems. A pilot study was conducted in four children weighing > 20 kg in whom it would usually be considered appropriate to use breathing systems designed for adult anaesthesia. The pilot study compared work of breathing using the Mapleson D breathing system and the Triservice Anaesthetic Apparatus (TSAA). Work of breathing was calculated using the modified Campbell technique that calculates work using a pressure volume loop derived from oesophageal pressure and airway gas volume measurements. We found no difference in the work of breathing when comparing the Mapleson D and the TSAA in children > 20 kg. Following completion of the pilot study, we conducted a study on 10 children weighing between 10 and 20 kg comparing work of breathing using the Mapleson F breathing system and the TSAA. We found no significant difference in the work of breathing between the Mapleson F and the TSAA for these children. The TSAA can therefore be recommended for use down to a lower weight limit of 10 kg.

  5. Spontaneous breathing during anaesthesia: first, do no harm

    OpenAIRE

    Drummond, Gordon B

    2007-01-01

    Controlled respiration and mechanical ventilation have long been part of anaesthetic practice. Modern surgery, anaesthetic techniques, and new agents require a reappraisal of this established habit. In many circumstances the adverse effects of mechanical ventilation can be avoided by the use of the laryngeal mask and allowing spontaneous ventilation. In addition to the more prominent advantages, such as less sore throat, reliable assessment of anaesthetic depth, and good recovery, there may b...

  6. Interaction between carbon dioxide absorbents and volatile anaesthetics in a closed anaesthesia breathing system

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    Miljenko Križmarić

    2011-11-01

    Full Text Available Background: Desiccation of the carbon dioxide (CO2 absorbent in an anaesthetic breathing system results in a discrepancy between the desired (selected and actual (measured levels of volatile anaesthetic; the measured value is lower than the selected value, which may make the induction of anaesthesia difficult. Moreover, because of a complicated interaction between the absorbent and the anaesthetic agent, toxic gases are formed within the system, which cannot be detected by standard monitoring during anaesthesia. The aim of this study was to check if the personnel responsible for changing the absorbent are aware of this problem, and to provide guidelines for its prevention. Method: A descriptive pilot study was conducted on a sample of 25 anaesthesia nurses from five Slovene hospitals performing surgical procedures under general anaesthesia. Data was gathered with an open-type questionnaire. Results: We found that 92 % of the study participants had noticed discrepancies between the selected and measured levels of anaesthetic agent in the breathing system, which ranged between 10 % and 50 %. A large proportion of the nurses (64 % did not consider CO2 absorber to be a possible source of the observed discrepancies. Only one nurse knew that the problem was caused by absorbent desiccation. Guidelines for absorbent replacement vary among hospitals, and so absorbents are changed at different intervals.Conclusion: The majority of nurses in our study were not aware that absorbent desiccation can significantly reduce the level of volatile anaesthetics in the breathing system. The problem can be prevented by adopting appropriate guidelines, which guarantee that absorbents are changed regularly as required.

  7. A new anaesthetic breathing system combining Mapleson A, D and E principles. A simple apparatus for low flow universal use without carbon dioxide absorption.

    Science.gov (United States)

    Humphrey, D

    1983-04-01

    A new simple anaesthetic breathing system is described which has been designed to incorporate into a single system advantages of Mapleson A, D and E type systems. Coaxial and non-coaxial versions are available. The system can be used for adults, children or neonates and allows both spontaneous or controlled ventilation with low fresh gas flows at all times. As a Mapleson A system for spontaneous respiration a considerable saving of anaesthetic gases and vapours is achieved since, for adults, the new system requires a lower fresh gas flow even than that for the Magill. For children breathing spontaneously the system requires only one third of the fresh gas flow necessary for the Jackson Rees modification of Ayre's T-piece. For controlled ventilation the system behaves as a modified Mapleson D/E (Bain type) system with the advantage of predictable CO2 tensions and good humidification. The system is safe, simple in design and operation, and is easily sterilized. Further it offers low resistance to expiration and facilitates scavenging at all times which, with low anaesthetic gas flows, permits complete theatre pollution control. Its potential application in academic and rural environments and major advantages over the circle absorber system are discussed.

  8. Tubulo-glomerular feedback response: enhancement in adult spontaneously hypertensive rats and effects of anaesthetics

    DEFF Research Database (Denmark)

    Leyssac, P P; Holstein-Rathlou, N H

    1989-01-01

    ) and stop-flow pressures (40.0-42.4 mm Hg) were similar in the four groups, but systemic arterial pressure was significantly lower in WKY, and significantly higher in SHR than in SPRD. The turning point (Tp) of the feedback curve was 9.87 nl/min in SHR, significantly lower than the 13.04 nl/min found in WKY......Open-loop tubulo-glomerular feedback (TGF) responses were measured in halothane anaesthetized spontaneously hypertensive rats (SHR), in normotensive Wistar Kyoto (WKY) and Sprague-Dawley rats (SPRD), and in inactin anaesthetized SPRD. Proximal intratubular free flow pressures (FFP) (13.8-14.7 mm Hg...

  9. The analysis of fresh gas flow in a circle anaesthetic breathing system, and its influence on CO2 absorbent desiccation

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    Miljenko Križmarić

    2012-04-01

    Full Text Available Background: If at the end of anaesthesia, the gases on the anaesthetic machine are not turned off, they continue to flow through the breathing circuit and may dry out the carbon dioxide absorbent in the absorber. At the beginning of the next anaesthetic procedure, the desiccated absorbent decomposes the volatile anaesthetic, resulting in the formation of toxic gas mixtures, which are dangerous for the patient. In such circumstances, the measured level of the volatile anaesthesic in the breathing circuit differs from the selected value. In the paper, we analyse potentially dangerous possible directions of continuous flow of fresh gas mixture in different anaesthetic breathing circuits. Methods: In the first part of the study, we simulated the continuous flow of gases in a Sulla anaesthesia machine using an experimental method in a simulation setting. In the second part, we analysed whether a retrograde flow through the absorber was possible in a convential anaesthetic breathing circuit and in the Fabius GS, Cato, Julian and Primus circuits with the Y-piece connector open or closed. Information on users’ requests for maintenance services due to discrepancies between the desired and measured levels of the volatile anaesthetic in the breathing circuit were obtained from the manufacturer’s local servicing agent. Results: In a Dräger ISO 8 circle system (Sulla anaesthetic machine with a standard gas supply connector, a retrograde flow is not possible. If the Y-piece connector is left open, the gases are vented to the outside via the absorber and the inspiratory tube. If the Y-piece connector is closed or open, the absorbent in the canister dries because of the continuous flow of gas. A retrograde flow is possible only in those Sulla anaesthetic machines where the fresh gas inlet is located below the inspiratory valve. A retrograde flow of gases causing absorbent desiccation can occur in a Cato, Julian, Fabius GS, or Primus anaesthetic machines

  10. [A respiratory microvalve for spontaneously breathing anesthetized small animals].

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    Barnikol, W K; Hiller, B; Guth, S

    1994-03-01

    For the accurate functional analysis of the gas exchange in the lungs or evaluation of artificial oxygen carriers in spontaneously breathing anaesthetized small animals, we developed a new respiratory micro-valve. The body of the valve is made of aluminium, and the flaps are made of silicone rubber. The maximum flow rate in a rat measured with a pneumotachograph and the micro-valve was an average of 19.9 ml/s during inspiration, and 17.8 ml/s during expiration. The pressure measured in the tracheal tube was -0.85 during inspiration, and +0.39 cm H2O during expiration; the end-expiratory pressure in the tube was zero. In two experiments with anaesthetised rats lasting 4-5 hours, ventilation, oxygen uptake, carbon dioxide release and the respiratory exchange ratio were 638 ml/min/kg, 21.7 ml O2(STPD)/min/kg, 16.6 ml CO2(STPD)/min/kg, and 0.77, respectively. There was no significant change in any parameter during the experiment. The micro-valve increases the dead space by approximately 35%, but this is well tolerated by the rats, which compensate by increasing their tidal volume by about 10 to 15%. The major advantage of using the micro-valve in comparison with other methods is the fact that the true difference between inspiratory and mean mixed expiratory gas can be measured with great accuracy. The micro-valve can readily be adjusted for optimal use with a range of animals.

  11. Tubulo-glomerular feedback response: enhancement in adult spontaneously hypertensive rats and effects of anaesthetics

    DEFF Research Database (Denmark)

    Leyssac, P P; Holstein-Rathlou, N H

    1989-01-01

    Open-loop tubulo-glomerular feedback (TGF) responses were measured in halothane anaesthetized spontaneously hypertensive rats (SHR), in normotensive Wistar Kyoto (WKY) and Sprague-Dawley rats (SPRD), and in inactin anaesthetized SPRD. Proximal intratubular free flow pressures (FFP) (13.8-14.7 mm Hg......) and stop-flow pressures (40.0-42.4 mm Hg) were similar in the four groups, but systemic arterial pressure was significantly lower in WKY, and significantly higher in SHR than in SPRD. The turning point (Tp) of the feedback curve was 9.87 nl/min in SHR, significantly lower than the 13.04 nl/min found in WKY...... anaesthetized control group of SPRD, the feedback response was lower, and the feedback curve was displaced to the right with the Tp at 15.9 nl/min, significantly higher than in the control group (p less than 0.001). Although the steady state level also was reached within 2 min, the clearly biphasic pattern...

  12. Voluntary breath holding affects spontaneous brain activity measured by magnetoencephalography

    NARCIS (Netherlands)

    Schellart, N. A.; Reits, D.

    1999-01-01

    Spontaneous brain activity was measured by multichannel magnetoencephalography (MEG) during voluntary breath holds. Significant changes in the activity are limited to the alpha rhythm: 0.25 Hz frequency increase and narrowing of the peak. The area of alpha activity shifts slightly toward (fronto-)

  13. Ventilation and Haemodynamic Indicators in Spontaneously Breathing Pigs under General Anaesthesia

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    Jiří Kobr

    2010-01-01

    Full Text Available The aim of this study was to obtain ventilation and haemodynamic data of healthy piglets under general anaesthesia for future patho-physiological experimental studies. A total of 34 domestic piglets of the Czech Black Pied (Přeštice breed were used in the study. The animals (male to female ratio 8 : 9 were six weeks old and their average body mass was 22 kg. A general anaesthetic (fentanyl and azaperon was introduced via a pulmonary artery catheter and the spontaneously breathing animals were monitored for 60 min. Cardiac output and haemodynamic indicators were established using intermittent pulmonary artery thermodilution. Blood gas data were deduced using fan dynamic parameters of ventilation and ventilation indices. The study yielded reliable data of dynamic lung indicators (p 2O/kg, and haemodynamic indicators (p < 0.01 such as cardiac output 2.12 ± 0.75 l/min, pulmonary vascular resistance 3.92 ± 0.52 and systemic vascular resistance 15.8 ± 6.81 Woods units. Reliable data regarding lung dynamics, cardiac output, preload and afterload of both heart ventricles in spontaneously breathing healthy piglets under general anaesthesia were achieved.

  14. Changes in breathing variables during a 30-minute spontaneous breathing trial.

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    Figueroa-Casas, Juan B; Connery, Sean M; Montoya, Ricardo

    2015-02-01

    Spontaneous breathing trials (SBTs) are increasingly performed. Significant changes in monitored breathing variables and the timing of those changes during the trial have important implications for its outcome determination and supervision. We aimed to study the magnitude and timing of change in breathing variables during the course of a 30-min SBT. Breathing variables were continuously measured and averaged by minute during the SBT in 32 subjects with trial success and 8 subjects with trial failure from a general ICU population. Percentage changes in breathing variables during the trial and proportions of subjects showing a ≥20% change at different time points relative to the second minute of the trial were calculated. The commonly monitored breathing variables (frequency, tidal volume, their ratio, and minute ventilation) showed median coefficients of variation of breathing variables remain relatively constant, and potentially significant changes in these variables after 10 min into the trial are uncommon. These findings should be considered when addressing aspects of duration and supervision of SBTs in weaning protocols. Copyright © 2015 by Daedalus Enterprises.

  15. Different spontaneous breathing trials in patients with atrial fibrillation

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    Y.-H. Tseng

    2015-09-01

    Full Text Available Introduction: Weaning from mechanical ventilation is one of the most important and challenging problems for most intensive care unit (ICU patients. Spontaneous breathing trial (SBT is the most common method used to evaluate patients’ ability to breathe by themselves and plays an important role in decision making for weaning. The aim of our study was to investigate the effect of different methods of SBT in respiratory care unit (RCU patients with atrial fibrillation (AF on weaning outcome. Methods: We retrospectively analyzed different methods of SBT in patients with and without AF. We enrolled RCU patients who required mechanical ventilation and had undergone transthoracic echocardiography from January 2011 to January 2012. Results: There was a higher SBT passing rate among AF patients who received pressure support ventilation (PSV trial than in those who received T-piece trail (92.5% vs. 73.1%, p = 0.041. The weaning rates between these two groups were not significantly different (83.8% vs. 94.7%, p = 0.403. Total ventilator days were longer in T-piece group than in PSV group (median 40.0, IQR: 18.2–125.1 days vs. 33.0, IQR: 29.6–51.0 days respectively, p = 0.580, but this difference was not statistically significant. These results were not found in patients without AF. Conclusions: The use of PSV trial might be considered first instead of T-piece trial for SBT when AF patients were ready to wean. Keywords: Atrial fibrillation (AF, Intensive care unit (ICU, Mechanical ventilation, Spontaneous breathing trial (SBT, Ventilator weaning

  16. Mapleson's Breathing Systems

    OpenAIRE

    Kaul, Tej K; Mittal, Geeta

    2013-01-01

    Mapleson breathing systems are used for delivering oxygen and anaesthetic agents and to eliminate carbon dioxide during anaesthesia. They consist of different components: Fresh gas flow, reservoir bag, breathing tubes, expiratory valve, and patient connection. There are five basic types of Mapleson system: A, B, C, D and E depending upon the different arrangements of these components. Mapleson F was added later. For adults, Mapleson A is the circuit of choice for spontaneous respiration where...

  17. [Usefulness of monitoring anaesthesia with the bispectral index in upper gastrointestinal endoscopies with spontaneous breathing].

    Science.gov (United States)

    Alados-Arboledas, F J; Millán-Bueno, M P; Expósito-Montes, J F; Santiago-Gutierrez, C; Arévalo-Garrido, A; Pérez-Parras, A; Millán-Miralles, L; Martínez-Padilla, M C; de la Cruz-Moreno, J

    2013-08-01

    The objective of this investigation is to determine whether bispectral index (BIS®) monitoring during intravenous anaesthesia with spontaneous breathing for upper gastrointestinal endoscopy (UGE) in a pediatric population is useful for: a) decreasing the amount of drug, b) decreasing the time for awakening, and c) improving patient safety. A quasi-experimental case-control prospective study was conducted in the setting of a second level hospital pediatric intensive care unit. Children aged 1-13 years. ASA I patient who needed a diagnostic UGE; eligible, 36, participants, 30. historical cohort of patients who needed UGE (years 2008-2010): 50 patients. UGE performed with anaesthetic protocol, vital signs monitoring, sedation level (Ramsay scale) and BIS monitoring. propofol total dose (mg/kg), induction time, time in performing the UGE, awakening time (min); initial BIS (iBIS), and BIS during the UGE; adverse effects. There were no significant differences in sex, age or weight between case (B) and control (C) population. No significant differences in total propofol doses: (B 4.9 ± 1.4 mg/kg; C 5.2 ± 1.6 mg/kg, P=.492), awakening time (B 12.2 ± 4.6 min; C 12.8 ± 4.4 min, P=.402), time for execution of UGE (B 9.5 ± 4.8 min; C 11.3 ± 6.5 min, P=.335) and induction time (B 11.1 ± 2.6 min; C 10.1 ± 4.2 min, P=.059), iBIS 55.4 ± 6.9. There were no significant differences in adverse effects: 2 patients suffered from mild desaturation in the control group. BIS monitoring for diagnostic UGE in spontaneous breathing in a pediatric population is feasible, but does not appear to decrease awakening time or the amount of propofol needed. Furthermore, there was no statistically significant decrease in the number of adverse effects. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  18. Effort to Breathe with Various Spontaneous Breathing Trial Techniques. A Physiologic Meta-analysis.

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    Sklar, Michael C; Burns, Karen; Rittayamai, Nuttapol; Lanys, Ashley; Rauseo, Michela; Chen, Lu; Dres, Martin; Chen, Guang-Qiang; Goligher, Ewan C; Adhikari, Neill K J; Brochard, Laurent; Friedrich, Jan O

    2017-06-01

    Spontaneous breathing trials (SBTs) are designed to simulate conditions after extubation, and it is essential to understand the physiologic impact of different methods. We conducted a systematic review and pooled measures reflecting patient respiratory effort among studies comparing SBT methods in a meta-analysis. We searched Medline, Excerpta Medica Database, and Web of Science from inception to January 2016 to identify randomized and nonrandomized clinical trials reporting physiologic measurements of respiratory effort (pressure-time product) or work of breathing during at least two SBT techniques. Secondary outcomes included the rapid shallow breathing index (RSBI), and effort measured before and after extubation. The quality of physiologic measurement and research design was appraised for each study. Outcomes were analyzed using ratio of means. Among 4,138 citations, 16 studies (n = 239) were included. Compared with T-piece, pressure support ventilation significantly reduced work by 30% (ratio of means [RoM], 0.70; 95% confidence interval [CI], 0.57-0.86), effort by 30% (RoM, 0.70; 95% CI, 0.60-0.82), and RSBI by 20% (RoM, 0.80; 95% CI, 0.75-0.86). Continuous positive airway pressure had significantly lower pressure-time product by 18% (RoM, 0.82; 95% CI, 0.68-0.999) compared with T-piece, and reduced RSBI by 16% (RoM, 0.84; 95% CI, 0.74-0.95). Studies comparing SBTs with the postextubation period demonstrated that pressure support induced significantly lower effort and RSBI; T-piece reduced effort, but not the work, compared with postextubation. Work, effort, and RSBI measured while intubated on the ventilator with continuous positive airway pressure of 0 cm H 2 O were no different than extubation. Pressure support reduces respiratory effort compared with T-piece. Continuous positive airway pressure of 0 cm H 2 O and T-piece more accurately reflect the physiologic conditions after extubation.

  19. Humidification performance of humidifying devices for tracheostomized patients with spontaneous breathing: a bench study.

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    Chikata, Yusuke; Oto, Jun; Onodera, Mutsuo; Nishimura, Masaji

    2013-09-01

    Heat and moisture exchangers (HMEs) are commonly used for humidifying respiratory gases administered to mechanically ventilated patients. While they are also applied to tracheostomized patients with spontaneous breathing, their performance in this role has not yet been clarified. We carried out a bench study to investigate the effects of spontaneous breathing parameters and oxygen flow on the humidification performance of 11 HMEs. We evaluated the humidification provided by 11 HMEs for tracheostomized patients, and also by a system delivering high-flow CPAP, and an oxygen mask with nebulizer heater. Spontaneous breathing was simulated with a mechanical ventilator, lung model, and servo-controlled heated humidifier at tidal volumes of 300, 500, and 700 mL, and breathing frequencies of 10 and 20 breaths/min. Expired gas was warmed to 37°C. The high-flow CPAP system was set to deliver 15, 30, and 45 L/min. With the 8 HMEs that were equipped with ports to deliver oxygen, and with the high-flow CPAP system, measurements were taken when delivering 0 and 3 L/min of dry oxygen. After stabilization we measured the absolute humidity (AH) of inspired gas with a hygrometer. AH differed among HMEs applied to tracheostomized patients with spontaneous breathing. For all the HMEs, as tidal volume increased, AH decreased. At 20 breaths/min, AH was higher than at 10 breaths/min. For all the HMEs, when oxygen was delivered, AH decreased to below 30 mg/L. With an oxygen mask and high-flow CPAP, at all settings, AH exceeded 30 mg/L. None of the HMEs provided adequate humidification when supplemental oxygen was added. In the ICU, caution is required when applying HME to tracheostomized patients with spontaneous breathing, especially when supplemental oxygen is required.

  20. Time-varying respiratory system elastance: a physiological model for patients who are spontaneously breathing.

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    Chiew, Yeong Shiong; Pretty, Christopher; Docherty, Paul D; Lambermont, Bernard; Shaw, Geoffrey M; Desaive, Thomas; Chase, J Geoffrey

    2015-01-01

    Respiratory mechanics models can aid in optimising patient-specific mechanical ventilation (MV), but the applications are limited to fully sedated MV patients who have little or no spontaneously breathing efforts. This research presents a time-varying elastance (E(drs)) model that can be used in spontaneously breathing patients to determine their respiratory mechanics. A time-varying respiratory elastance model is developed with a negative elastic component (E(demand)), to describe the driving pressure generated during a patient initiated breathing cycle. Data from 22 patients who are partially mechanically ventilated using Pressure Support (PS) and Neurally Adjusted Ventilatory Assist (NAVA) are used to investigate the physiology relevance of the time-varying elastance model and its clinical potential. E(drs) of every breathing cycle for each patient at different ventilation modes are presented for comparison. At the start of every breathing cycle initiated by patient, E(drs) is 25 cmH2Os/l and thus can be used as an acute respiratory distress syndrome (ARDS) severity indicator. The E(drs) model captures unique dynamic respiratory mechanics for spontaneously breathing patients with respiratory failure. The model is fully general and is applicable to both fully controlled and partially assisted MV modes.

  1. Time-varying respiratory system elastance: a physiological model for patients who are spontaneously breathing.

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    Yeong Shiong Chiew

    Full Text Available BACKGROUND: Respiratory mechanics models can aid in optimising patient-specific mechanical ventilation (MV, but the applications are limited to fully sedated MV patients who have little or no spontaneously breathing efforts. This research presents a time-varying elastance (E(drs model that can be used in spontaneously breathing patients to determine their respiratory mechanics. METHODS: A time-varying respiratory elastance model is developed with a negative elastic component (E(demand, to describe the driving pressure generated during a patient initiated breathing cycle. Data from 22 patients who are partially mechanically ventilated using Pressure Support (PS and Neurally Adjusted Ventilatory Assist (NAVA are used to investigate the physiology relevance of the time-varying elastance model and its clinical potential. E(drs of every breathing cycle for each patient at different ventilation modes are presented for comparison. RESULTS: At the start of every breathing cycle initiated by patient, E(drs is 25 cmH2Os/l and thus can be used as an acute respiratory distress syndrome (ARDS severity indicator. CONCLUSION: The E(drs model captures unique dynamic respiratory mechanics for spontaneously breathing patients with respiratory failure. The model is fully general and is applicable to both fully controlled and partially assisted MV modes.

  2. Can a central blood volume deficit be detected by systolic pressure variation during spontaneous breathing?

    DEFF Research Database (Denmark)

    Dahl, Michael; Hayes, Chris; Steen Rasmussen, Bodil

    2016-01-01

    BACKGROUND: Whether during spontaneous breathing arterial pressure variations (APV) can detect a volume deficit is not established. We hypothesized that amplification of intra-thoracic pressure oscillations by breathing through resistors would enhance APV to allow identification of a reduced...... resistors. A brachial arterial catheter was used to measure blood pressure and thus systolic pressure variation (SPV), pulse pressure variation and stroke volume variation . Pulse contour analysis determined stroke volume (SV) and CO and we evaluated whether APV could detect a 10 % decrease in CO. RESULTS...... (from 21 (±15)% to 30 (±13)%). Yet during head-up tilt, a SPV ≥ 37 % predicted a decrease in CO ≥ 10 % with a sensitivity and specificity of 78 % and 100 %, respectively. CONCLUSION: In spontaneously breathing healthy volunteers combined inspiratory and expiratory resistors enhance SPV during head...

  3. An expiratory assist during spontaneous breathing can compensate for endotracheal tube resistance.

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    Uchiyama, Akinori; Chang, Cheng; Suzuki, Shinya; Mashimo, Takashi; Fujino, Yuji

    2009-08-01

    Although inspiratory assist of spontaneous breathing in intubated patients is common, expiratory assist functions have rarely been reported. Effective expiratory support (ES) could be used to compensate for endotracheal tube (ETT) resistance during spontaneous breathing. In this study, we examined the performance of a new system designed to provide both inspiratory support (IS) and ES during spontaneous breathing with the goal of reducing the effective resistance of the ETT. The ES system consisted of a ventilator demand valve and a computer-controlled piston cylinder, which aspirated gas from the respiratory circuit during the expiratory phase. The movement of the piston was synchronized with spontaneous breathing. We compared the pressures at the tip of the ETT and in the breathing circuit during spontaneous breathing through an ETT of internal diameter (ID) 5 mm with that of an ETT with ID 8 mm in nine healthy adult male volunteers. The ventilatory mode was set to maintain a continuous airway pressure of 0 cm H(2)O. Three ventilator settings (no support, IS only, and IS plus ES) were compared using ID 5 mm ETT. We monitored pressure in the breathing circuit (P(aw)), ETT tip pressure (P(tip)), and respiratory flow. The P(tip) of the ID 5 mm ETT showed a large negative deflection during inspiration and a positive deflection during expiration without support. IS alone did not improve the respiratory pattern through the small ETT. However, IS plus ES resulted in negative P(aw) during expiration in addition to positive deflection of P(aw) during inspiration, making the pressure characteristics of P(tip) similar to those of ID 8 mm ETT. Moreover, IS plus ES produced a respiratory pattern through the ID 5 mm ETT that was similar to that through the ID 8 mm ETT. In this study of healthy volunteers, IS plus ES compensated for the airway resistance imposed by a ID 5.0 mm ETT to create pressure changes at the tip of the ETT similar to those of an ID 8.0 mm ETT.

  4. [Nursing outcomes for ineffective breathing patterns and impaired spontaneous ventilation in intensive care].

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    do Canto, Débora Francisco; Almeida, Miriam de Abreu

    2013-12-01

    This study aimed to validate the results of Nursing selected from the link NANDA-I-NOC (Nursing Outcomes Classification--NANDA--International) for diagnosis Ineffective Breathing Pattern and Impaired Spontaneous Ventilation in adult intensive care unit. This is a content validation study conducted in a university hospital in southern Brazil with 15 expert nurses with clinical experience and knowledge of the ratings. The instruments contained five-point Likert scales to rate the importance of each outcome (1st step) and indicator (Step 2) for the diagnoses studied. We calculated weighted averages for each outcome/indicator, considering) 1 = 0. 2 = 0.25, 3 = 0.50 4 = 0.75 and 5 = 1. The outcomes suggested by the NOC with averages above 0.8 were considered validated as well as the indicators. The results Respiratory State--airway permeability (Ineffective Breathing Patterns) and 11 indicators, and Response to mechanical ventilation: adult (Impaired Spontaneous Ventilation) with 26 indicators were validated.

  5. In vitro evaluation of heat and moisture exchangers designed for spontaneously breathing tracheostomized patients.

    Science.gov (United States)

    Brusasco, Claudia; Corradi, Francesco; Vargas, Maria; Bona, Margherita; Bruno, Federica; Marsili, Maria; Simonassi, Francesca; Santori, Gregorio; Severgnini, Paolo; Kacmarek, Robert M; Pelosi, Paolo

    2013-11-01

    Heat and moisture exchangers (HMEs) are commonly used in chronically tracheostomized spontaneously breathing patients, to condition inhaled air, maintain lower airway function, and minimize the viscosity of secretions. Supplemental oxygen (O2) can be added to most HMEs designed for spontaneously breathing tracheostomized patients. We tested the efficiency of 7 HMEs designed for spontaneously breathing tracheostomized patients, in a normothermic model, at different minute ventilations (VE) and supplemental O2 flows. HME efficiency was evaluated using an in vitro lung model at 2 VE (5 and 15 L/min) and 4 supplemental O2 flows (0, 3, 6, and 12 L/min). Wet and dry temperatures of the inspiratory flow were measured, and absolute humidity was calculated. In addition, HME efficiency at 0, 12, and 24 h use was evaluated, as well as resistance to flow at 0 and 24 h. The progressive increase in O2 flow from 0 to 12 L/min was associated with a reduction in temperature and absolute humidity. Under the same conditions, this effect was greater at lower VE. The HME with the best performance provided an absolute humidity of 26 mg H2O/L and a temperature of 27.8 °C. No significant changes in efficiency or resistance were detected during the 24 h evaluation. The efficiency of HMEs in terms of temperature and absolute humidity is significantly affected by O2 supplementation and V(E).

  6. Comparison of trapezius squeeze test and jaw thrust as clinical indicators for laryngeal mask airway insertion in spontaneously breathing children

    Directory of Open Access Journals (Sweden)

    K K Dinesh Kumar

    2017-01-01

    Conclusion: Both JT and TPZ are equivalent clinical indicators in predicting the optimal conditions of LMA insertion in spontaneously breathing children; however, it takes a longer time to achieve a negative TPZ squeeze test.

  7. Respiratory variations in the photoplethysmographic waveform: acute hypovolaemia during spontaneous breathing is not detected

    International Nuclear Information System (INIS)

    Nilsson, Lena; Goscinski, Tomas; Lindenberger, Marcus; Länne, Toste; Johansson, Anders

    2010-01-01

    Recent studies using photoplethysmographic (PPG) signals from pulse oximeters have shown potential to assess hypovolaemia during spontaneous breathing. This signal is heavily filtered and reports are based on respiratory variations in the small pulse synchronous variation of PPG. There are stronger respiratory variations such as respiratory synchronous variation (PPGr) in the baseline of the unfiltered PPG signal. We hypothesized that PPGr would increase during hypovolaemia during spontaneous breathing. Hemodynamic and respiratory data were recorded together with PPG infrared signals from the finger, ear and forearm from 12 healthy male volunteers, at rest and during hypovolaemia created by the application of a lower body negative pressure (LBNP) of 15, 30 and 60 cmH 2 O. Hemodynamic and respiratory values changed significantly. From rest to the LBNP of 60 cmH 2 O systolic blood pressure fell from median (IQR) 116 (16) to 101 (23) mmHg, the heart rate increased from 58 (16) to 73 (16) beats min −1 , and the respiratory rate increased from 9.5 (2.0) to 11.5 (4.0) breaths min −1 . The amplitude of PPGr did not change significantly at any measurement site. The strongest effect was seen at the ear, where the LBNP of 60 cmH 2 O gave an amplitude increase from 1.0 (0.0) to 1.31 (2.24) AU. PPG baseline respiratory variations cannot be used for detecting hypovolaemia in spontaneously breathing subjects

  8. Whole body hyperthermia by extracorporeal circulation in spontaneously breathing sarcoma patients: hemodynamics and oxygen metabolism.

    Science.gov (United States)

    Locker, Gottfried J; Fuchs, Eva-Maria; Worel, Nina; Bojic, Andja; Heinrich, Gerhard; Brodowicz, Thomas; Clodi, Martin; Funk, Georg-Christian; Knöbl, Paul; Zielinski, Christoph C; Köstler, Wolfgang J

    2011-11-01

    This phase I study was performed to evaluate the feasibility and toxicity of a new method of extracorporeal perfusion-induced whole body hyperthermia (WBHT) in patients with advanced sarcoma avoiding the need of intubation and general anesthesia. One double-lumen femoral venous access was inserted by Seldinger's technique to obtain WBHT (41.8°C for 120 minutes) via an extracorporeal circuit. No concomitant chemotherapy was applied. Up to 4 treatments of WBHT were performed under moderate sedation in 6 spontaneously breathing patients. Invasive hemodynamic monitoring was performed by use of a pulmonary artery catheter. After their first WBHT session, 2 patients were excluded from further treatment due to transient liver toxicity or catheter-related complication, so a total of 12 cycles remained for analyses. In all patients, conscious sedation resulted in sufficient spontaneous respiration without the need for mandatory ventilation. Median time to reach the target temperature was 84 minutes (range 60-142). Hemodynamic changes revealed the expected hyperdynamic state: heart rate, cardiac index, and stroke volume index significantly increased (pmean; 0.062 µg·kg¹·min⁻¹) were necessary to maintain the mean arterial blood pressure >60 mmHg. Our data demonstrate the feasibility of this method of extracorporeal WBHT without mandatory ventilation. Hemodynamic side effects in spontaneously breathing patients during perfusion-induced WBHT seem less severe than those observed in radiant heat WBHT.

  9. The effects of passive humidifier dead space on respiratory variables in paralyzed and spontaneously breathing patients.

    Science.gov (United States)

    Campbell, R S; Davis, K; Johannigman, J A; Branson, R D

    2000-03-01

    Passive humidifiers have gained acceptance in the intensive care unit because of their low cost, simple operation, and elimination of condensate from the breathing circuit. However, the additional dead space of these devices may adversely affect respiratory function in certain patients. This study evaluates the effects of passive humidifier dead space on respiratory function. Two groups of patients were studied. The first group consisted of patients recovering from acute lung injury and breathing spontaneously on pressure support ventilation. The second group consisted of patients who were receiving controlled mechanical ventilation and were chemically paralyzed following operative procedures. All patients used 3 humidification devices in random order for one hour each. The devices were a heated humidifier (HH), a hygroscopic heat and moisture exchanger (HHME) with a dead space of 28 mL, and a heat and moisture exchanger (HME) with a dead space of 90 mL. During each measurement period the following were recorded: tidal volume, minute volume, respiratory frequency, oxygen consumption, carbon dioxide production, ratio of dead space volume to tidal volume (VD/VT), and blood gases. In the second group, intrinsic positive end-expiratory pressure was also measured. Addition of either of the passive humidifiers was associated with increased VD/VT. In spontaneously breathing patients, VD/VT increased from 59 +/- 13 (HH) to 62 +/- 13 (HHME) to 68 +/- 11% (HME) (p < 0.05). In these patients, constant alveolar ventilation was maintained as a result of increased respiratory frequency, from 22.1 +/- 6.6 breaths/min (HH) to 24.5 +/- 6.9 breaths/min (HHME) to 27.7 +/- 7.4 breaths/min (HME) (p < 0.05), and increased minute volume, from 9.1 +/- 3.5 L/min (HH) to 9.9 +/- 3.6 L/min (HHME) to 11.7 +/- 4.2 L/min (HME) (p < 0.05). There were no changes in blood gases or carbon dioxide production. In the paralyzed patient group, VD/VT increased from 54 +/- 12% (HH) to 56 +/- 10% (HHME

  10. Using an expiratory resistor, arterial pulse pressure variations predict fluid responsiveness during spontaneous breathing: an experimental porcine study.

    Science.gov (United States)

    Dahl, Michael K; Vistisen, Simon T; Koefoed-Nielsen, Jacob; Larsson, Anders

    2009-01-01

    Fluid responsiveness prediction is difficult in spontaneously breathing patients. Because the swings in intrathoracic pressure are minor during spontaneous breathing, dynamic parameters like pulse pressure variation (PPV) and systolic pressure variation (SPV) are usually small. We hypothesized that during spontaneous breathing, inspiratory and/or expiratory resistors could induce high arterial pressure variations at hypovolemia and low variations at normovolemia and hypervolemia. Furthermore, we hypothesized that SPV and PPV could predict fluid responsiveness under these conditions. Eight prone, anesthetized and spontaneously breathing pigs (20 to 25 kg) were subjected to a sequence of 30% hypovolemia, normovolemia, and 20% and 40% hypervolemia. At each volemic level, the pigs breathed in a randomized order either through an inspiratory and/or an expiratory threshold resistor (7.5 cmH2O) or only through the tracheal tube without any resistor. Hemodynamic and respiratory variables were measured during the breathing modes. Fluid responsiveness was defined as a 15% increase in stroke volume (DeltaSV) following fluid loading. Stroke volume was significantly lower at hypovolemia compared with normovolemia, but no differences were found between normovolemia and 20% or 40% hypervolemia. Compared with breathing through no resistor, SPV was magnified by all resistors at hypovolemia whereas there were no changes at normovolemia and hypervolemia. PPV was magnified by the inspiratory resistor and the combined inspiratory and expiratory resistor. Regression analysis of SPV or PPV versus DeltaSV showed the highest R2 (0.83 for SPV and 0.52 for PPV) when the expiratory resistor was applied. The corresponding sensitivity and specificity for prediction of fluid responsiveness were 100% and 100%, respectively, for SPV and 100% and 81%, respectively, for PPV. Inspiratory and/or expiratory threshold resistors magnified SPV and PPV in spontaneously breathing pigs during hypovolemia

  11. Spontaneous breathing test in the prediction of extubation failure in the pediatric population.

    Science.gov (United States)

    Nascimento, Milena Siciliano; Rebello, Celso Moura; Vale, Luciana Assis Pires Andrade; Santos, Érica; Prado, Cristiane do

    2017-01-01

    To assess whether the spontaneous breathing test can predict the extubation failure in pediatric population. A prospective and observational study that evaluated data of inpatients at the Pediatric Intensive Care Unit between May 2011 and August 2013, receiving mechanical ventilation for at least 24 hours followed by extubation. The patients were classified in two groups: Test Group, with patients extubated after spontaneous breathing test, and Control Group, with patients extubated without spontaneous breathing test. A total of 95 children were enrolled in the study, 71 in the Test Group and 24 in the Control Group. A direct comparison was made between the two groups regarding sex, age, mechanical ventilation time, indication to start mechanical ventilation and respiratory parameters before extubation in the Control Group, and before the spontaneous breathing test in the Test Group. There was no difference between the parameters evaluated. According to the analysis of probability of extubation failure between the two groups, the likelihood of extubation failure in the Control Group was 1,412 higher than in the Test Group, nevertheless, this range did not reach significance (p=0.706). This model was considered well-adjusted according to the Hosmer-Lemeshow test (p=0.758). The spontaneous breathing test was not able to predict the extubation failure in pediatric population. Avaliar se o teste de respiração espontânea pode ser utilizado para predizer falha da extubação na população pediátrica. Estudo prospectivo, observacional, no qual foram avaliados todos os pacientes internados no Centro de Terapia Intensiva Pediátrica, no período de maio de 2011 a agosto de 2013, que utilizaram ventilação mecânica por mais de 24 horas e que foram extubados. Os pacientes foram classificados em dois grupos: Grupo Teste, que incluiu os pacientes extubados depois do teste de respiração espontânea; e Grupo Controle, pacientes foram sem teste de respiração espont

  12. Coupled and reduced dimensional modeling of respiratory mechanics during spontaneous breathing.

    Science.gov (United States)

    Ismail, M; Comerford, A; Wall, W A

    2013-11-01

    In this paper, we develop a total lung model based on a tree of 0D airway and acinar models for studying respiratory mechanics during spontaneous breathing. This model utilizes both computer tomography-based geometries and artificially generated lobe-filling airway trees to model the entire conducting region of the lung. Beyond the conducting airways, we develop an acinar model, which takes into account the alveolar tissue resistance, compliance, and the intrapleural pressure. With this methodology, we compare four different 0D models of airway mechanics and determine the best model based on a comparison with a 3D-0D coupled model of the conducting airways; this methodology is possible because the majority of airway resistance is confined to the lower generations, that is, the trachea and the first few bronchial generations. As an example application of the model, we simulate the flow and pressure dynamics under spontaneous breathing conditions, that is, at flow conditions driven purely by pleural space pressure. The results show good agreement, both qualitatively and quantitatively, with reported physiological values. One of the key advantages of this model is the ability to provide insight into lung ventilation in the peripheral regions. This is often crucial because this is where information, specifically for studying diseases and gas exchange, is needed. Thus, the model can be used as a tool for better understanding local peripheral lung mechanics without excluding the upper portions of the lung. This tool will be also useful for in vitro investigations of lung mechanics in both health and disease. Copyright © 2013 John Wiley & Sons, Ltd.

  13. Spontaneous Breathing Trials and Conservative Sedation Practices Reduce Mechanical Ventilation Duration in Subjects With ARDS.

    Science.gov (United States)

    Kallet, Richard H; Zhuo, Hanjing; Yip, Vivian; Gomez, Antonio; Lipnick, Michael S

    2018-01-01

    Spontaneous breathing trials (SBTs) and daily sedation interruptions (DSIs) reduce both the duration of mechanical ventilation and ICU length of stay (LOS). The impact of these practices in patients with ARDS has not previously been reported. We examined whether implementation of SBT/DSI protocols reduce duration of mechanical ventilation and ICU LOS in a retrospective group of subjects with ARDS at a large, urban, level-1 trauma center. All ARDS survivors from 2002 to 2016 ( N = 1,053) were partitioned into 2 groups: 397 in the pre-SBT/DSI group (June 2002-December 2007) and 656 in the post-SBT/DSI group (January 2009-April 2016). Patients from 2008, during the protocol implementation period, were excluded. An additional SBT protocol database (2008-2010) was used to assess the efficacy of SBT in transitioning subjects with ARDS to unassisted breathing. Comparisons were assessed by either unpaired t tests or Mann-Whitney tests. Multiple comparisons were made using either one-way analysis of variance or Kruskal-Wallis and Dunn's tests. Linear regression modeling was used to determine variables independently associated with mechanical ventilation duration and ICU LOS; differences were considered statistically significant when P mechanical ventilation duration (14 [6-29] vs 9 [4-17] d, respectively, P mechanical ventilation duration and ICU LOS. Among subjects with ARDS in the SBT performance database, most achieved unassisted breathing with a median of 2 SBTs. Evidenced-based protocols governing weaning and sedation practices were associated with both reduced mechanical ventilation duration and ICU LOS in subjects with ARDS. However, higher respiratory system compliance in the SBT/DSI cohort also contributed to these improved outcomes. Copyright © 2018 by Daedalus Enterprises.

  14. Measurement of end-tidal carbon dioxide in spontaneously breathing children after cardiac surgery.

    Science.gov (United States)

    Rasera, Carmen Caroline; Gewehr, Pedro Miguel; Domingues, Adriana Maria Trevisan; Junior, Fernando Faria

    2011-09-01

    Respiratory monitoring is important after surgery to prevent pulmonary complications. End-tidal carbon dioxide (Petco(2)) measurement by capnometry is an indirect and noninvasive measurement of Pco(2) in blood and is accepted and recognized in critical care. To determine the correlation and level of agreement between Petco(2) and Paco(2) in spontaneously breathing children after cardiac surgery and to determine whether Petco(2) measured by using tidal volume (Vt-Petco(2)) or vital capacity (VC-Petco(2)) shows more or less significant correlation with Paco(2). Vt-Petco(2) and VC-Petco(2) by capnometry and Paco(2) by blood gas analysis were measured once a day after tracheal extubation. The determination coefficient and degree of bias between the methods were assessed in children with and without supplemental oxygen. A total of 172 Vt-Petco(2), VC-Petco(2), and Paco(2) values from 48 children were analyzed. The overall coefficients of determination were 0.84 (P breathing children, Vt-Petco(2) provided a more accurate estimate of Paco(2) than did VC-Petco(2), especially in children given little or no supplemental oxygen. The difference between the methods was significantly larger in the groups given 2 to 5 L of oxygen per minute.

  15. Model-based estimation of loop gain using spontaneous breathing: A validation study

    Science.gov (United States)

    Gederi, Elnaz; Nemati, Shamim; Edwards, Bradley A.; Clifford, Gari D.; Malhotra, Atul; Wellman, Andrew

    2014-01-01

    Non-invasive assessment of ventilatory control stability or loop gain (which is a key contributor in a number of sleep-related breathing disorders) has proven to be cumbersome. We present a novel multivariate autoregressive model that we hypothesize will enable us to make time-varying measurements of loop gain using nothing more than spontaneous fluctuations in ventilation and CO2. The model is adaptive to changes in the feedback control loop and therefore can account for system non-stationarities (e.g. changes in sleep state) and it is resistant to artifacts by using a signal quality measure. We tested this method by assessing its ability to detect a known increase in loop gain induced by proportional assist ventilation (PAV). Subjects were studied during sleep while breathing on continuous positive airway pressure (CPAP) alone (to stabilize the airway) or on CPAP + PAV. We show that the method tracked the PAV-induced increase in loop gain, demonstrating its time-varying capabilities, and it remained accurate in the face of measurement related artifacts. The model was able to detect a statistically significant increase in loop gain from 0.14 ± 10 on CPAP alone to 0.21 ± 0.13 on CPAP + PAV (p PAV-induced increase in loop gain was predominantly driven by an increase in controller gain. Taken together, these data provide compelling evidence for the validity of this technique. PMID:25038522

  16. Spontaneous breathing or mechanical ventilation alters lung compliance and tissue association of exogenous surfactant in preterm newborn rabbits.

    Science.gov (United States)

    Bohlin, Kajsa; Bouhafs, Rabea K L; Jarstrand, Connie; Curstedt, Tore; Blennow, Mats; Robertson, Bengt

    2005-05-01

    In preterm infants with respiratory distress syndrome, surfactant administration followed by immediate extubation to spontaneous breathing with nasal continuous positive airway pressure reduces the need for mechanical ventilation. With this treatment approach, repeated doses of surfactant are rarely indicated. We used a rabbit model to test the hypothesis that exogenous surfactant therapy followed by spontaneous breathing results in a more sustained initial treatment response compared with treatment followed by mechanical ventilation. Preterm rabbits (gestational age 28.5 d) were treated with pharyngeal deposition of 200 mg/kg radiolabeled surfactant (14C-Curosurf) and randomized to 4 h of spontaneous breathing or mechanical ventilation or to a control group, killed immediately after surfactant administration. With pharyngeal deposition, 46 +/- 10% (mean +/- SEM) of the administered surfactant reached the lungs. The dynamic lung-thorax compliance was higher in spontaneously breathing compared with mechanically ventilated animals (median, 9.9 and 0.75 ml x cm H2O(-1) x kg(-1), respectively; p mechanically ventilated animals (p mechanically ventilated animals. We conclude that the initial lung tissue association of exogenous surfactant is impaired by mechanical ventilation. This is associated with a reduction of dynamic compliance and evidence of increased surfactant inactivation.

  17. A nasal catheter for the measurement of end-tidal carbon dioxide in spontaneously breathing patients: a preliminary evaluation.

    Science.gov (United States)

    Raheem, Mohamed Samy Abdel; Wahba, Olaa M

    2010-04-01

    Several devices have been proposed to monitor end-tidal carbon dioxide tension (Petco(2)) in spontaneously breathing patients; however, many have been reported to be inaccurate. We designed this study to investigate the accuracy of a balloon-tipped nasal catheter in measuring Petco(2) in nontracheally intubated, spontaneously breathing patients. The catheter was assembled using a 14-F rubber Foley catheter, a tracheal tube pilot balloon, and the plastic sheath from an 18-gauge needle. The catheter was connected to the sampling tube of a gas analyzer. Petco(2) and Paco(2) were determined simultaneously in 20 otherwise healthy postsurgical patients while receiving oxygen. The mean Petco(2) - Paco(2) difference was -4.4 +/- 1.6 (SD) mm Hg with a correlation coefficient r = +0.87 (P breathing patients.

  18. Comparative study of minimal fresh gas flow used in Lack-Plus and Lack's circuit in spontaneously breathing anesthetized adults.

    Science.gov (United States)

    Theerapongpakdee, Sunchai; Sathitkarnmanee, Thepakorn; Tribuddharat, Sirirat; Sucher, Siwalai; Thananun, Maneerat; Nonlhaopol, Duangthida

    2016-01-01

    The Lack's circuit is a co-axial Mapleson A breathing system commonly used in spontaneously breathing anesthetized adults but still requires high fresh gas flow (FGF). The Lack-Plus circuit was invented with the advantage of lower FGF requirement. The authors compared the Lack-Plus and Lack's circuit for the minimal FGF requirement with no rebreathing in spontaneously breathing anesthetized adults. This was a randomized crossover study. We enrolled 24 adult patients undergoing supine elective surgery, with a body mass index ≤30 kg/m 2 and an American Society of Anesthesiologists physical status I-II. They were randomly allocated to group 1 (LP-L) starting with Lack-Plus then switching to Lack's circuit or group 2 (L-LP) (with the reverse pattern). After induction and intubation, anesthesia was maintained with 50% N 2 O/O 2 and desflurane (4%-6%) plus fentanyl titration to maintain an optimal respiratory rate between 10 and 16/min. Starting with the first circuit, all the patients were spontaneously breathing with a FGF of 4 L/min for 10 min, gradually decreased by 0.5 L/min every 5 min until FGF was 2.5 L/min. End-tidal CO 2 , inspired minimum CO 2 (ImCO 2 ), mean arterial pressure, and oxygen saturation were recorded until rebreathing (ImCO 2 >0 mmHg) occurred. The alternate anesthesia breathing circuit was used and the measurements were repeated. The respective minimal FGF at the point of rebreathing for the Lack-Plus and Lack's circuit was 2.7±0.8 and 3.3±0.5 L/min, respectively, p Lack-Plus circuit can be used safely and effectively, and it requires less FGF than Lack's circuit in spontaneously breathing anesthetized adults.

  19. Spontaneous sleep-like brain state alternations and breathing characteristics in urethane anesthetized mice.

    Directory of Open Access Journals (Sweden)

    Silvia Pagliardini

    Full Text Available Brain state alternations resembling those of sleep spontaneously occur in rats under urethane anesthesia and they are closely linked with sleep-like respiratory changes. Although rats are a common model for both sleep and respiratory physiology, we sought to determine if similar brain state and respiratory changes occur in mice under urethane. We made local field potential recordings from the hippocampus and measured respiratory activity by means of EMG recordings in intercostal, genioglossus, and abdominal muscles. Similar to results in adult rats, urethane anesthetized mice displayed quasi-periodic spontaneous forebrain state alternations between deactivated patterns resembling slow wave sleep (SWS and activated patterns resembling rapid eye movement (REM sleep. These alternations were associated with an increase in breathing rate, respiratory variability, a depression of inspiratory related activity in genioglossus muscle and an increase in expiratory-related abdominal muscle activity when comparing deactivated (SWS-like to activated (REM-like states. These results demonstrate that urethane anesthesia consistently induces sleep-like brain state alternations and correlated changes in respiratory activity across different rodent species. They open up the powerful possibility of utilizing transgenic mouse technology for the advancement and translation of knowledge regarding sleep cycle alternations and their impact on respiration.

  20. Manual versus target-controlled infusion remifentanil administration in spontaneously breathing patients.

    Science.gov (United States)

    Moerman, Annelies T; Herregods, Luc L; De Vos, Martine M; Mortier, Eric P; Struys, Michel M R F

    2009-03-01

    The combination of propofol-remifentanil for procedural deep sedation in spontaneously breathing patients is characterized by the frequent incidence of side effects, especially respiratory depression. These side effects may be due to either the drug combination or the drug delivery technique. Target-controlled infusion (TCI) might optimize drug delivery. In this prospective, randomized, double-blind study in patients undergoing elective colonoscopy, we thus tried to answer two questions: first, if adding remifentanil to propofol surpasses the disadvantages of the combination of these two products, and second, if administration of remifentanil via TCI decreases the incidence of side effects, compared to manually controlled administration. Patients undergoing elective colonoscopy were randomly assigned to receive remifentanil via manually controlled continuous infusion (MCI) (0.125 microg x kg(-1) x min(-1) for 2 min followed by a continuous infusion of 0.05 microg x kg(-1) x min(-1)), TCI remifentanil (1 ng/mL), or placebo (normal saline either as TCI or manual infusion of equivalent rate). All patients received TCI propofol, adjusted to a target concentration level that provided deep sedation in which patients were not responsive to verbal commands, but maintained spontaneous ventilation without assistance. Significantly more patients in the placebo group showed movement, cough and hiccup, which transiently interfered with the examination. There were no clinically significant differences in hemodynamic or recovery variables among all groups. Remifentanil administered via TCI resulted in a decrease in propofol requirements. The incidence of hypopnea and apnea was less frequent when remifentanil was administered via TCI compared to MCI (TCI n = 7, MCI n = 16, P n = 7, MCI n = 16, P < 0.05), compared to manually controlled administration of remifentanil.

  1. Mapleson's Breathing Systems.

    Science.gov (United States)

    Kaul, Tej K; Mittal, Geeta

    2013-09-01

    Mapleson breathing systems are used for delivering oxygen and anaesthetic agents and to eliminate carbon dioxide during anaesthesia. They consist of different components: Fresh gas flow, reservoir bag, breathing tubes, expiratory valve, and patient connection. There are five basic types of Mapleson system: A, B, C, D and E depending upon the different arrangements of these components. Mapleson F was added later. For adults, Mapleson A is the circuit of choice for spontaneous respiration where as Mapleson D and its Bains modifications are best available circuits for controlled ventilation. For neonates and paediatric patients Mapleson E and F (Jackson Rees modification) are the best circuits. In this review article, we will discuss the structure of the circuits and functional analysis of various types of Mapleson systems and their advantages and disadvantages.

  2. Breathing

    Science.gov (United States)

    ... smaller structures called bronchi. The process of breathing (respiration) is divided into two distinct phases, inspiration (inhalation) and expiration (exhalation). During inspiration, the diaphragm contracts and pulls downward while the muscles between the ribs contract and pull upward. This ...

  3. Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants.

    Science.gov (United States)

    Göpel, Wolfgang; Kribs, Angela; Härtel, Christoph; Avenarius, Stefan; Teig, Norbert; Groneck, Peter; Olbertz, Dirk; Roll, Claudia; Vochem, Matthias; Weller, Ursula; von der Wense, Axel; Wieg, Christian; Wintgens, Jürgen; Preuss, Michael; Ziegler, Andreas; Roth, Bernhard; Herting, Egbert

    2015-03-01

    Providing less invasive surfactant administration (LISA) to spontaneously breathing preterm infants has been reported to reduce mechanical ventilation and bronchopulmonary dysplasia (BPD) in randomised controlled trials. This large cohort study compared these outcome measures between LISA-treated infants and controls. Infants receiving LISA, who were born before 32 gestational weeks and enrolled in the German Neonatal Network, were matched to control infants by gestational age, umbilical cord pH, Apgar-score at 5 min, small for gestational age status, antenatal treatment with steroids, gender and highest supplemental oxygen during the first 12 h of life. Outcome data were compared with chi-square and Mann-Whitney U-tests and adjusted for multiple comparisons. Between 2009 and 2012, 1103 infants were treated with LISA at 37 centres. LISA infants had lower rates of mechanical ventilation (41% versus 62%, p mechanical ventilation and BPD. Additional large-scale randomised controlled trials are needed to assess the possible long-term benefits of LISA. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  4. Analysis of ineffective breathing pattern and impaired spontaneous ventilation of adults with oxygen therapy 1

    Science.gov (United States)

    Seganfredo, Deborah Hein; Beltrão, Beatriz Amorim; da Silva, Viviane Martins; Lopes, Marcos Venícios de Oliveira; Castro, Stela Maris de Jezus; Almeida, Miriam de Abreu

    2017-01-01

    ABSTRACT Objective: to analyze the manifestation of the defining characteristics of the nursing diagnoses of ineffective breathing pattern and impaired spontaneous ventilation, of the NANDA International and the defining characteristics identified in the literature for the concept of “ventilation” in adult patients hospitalized in an intensive care unit with use of oxygen therapy. Method: clinical diagnostic validation study, conducted with 626 patients in intensive care using oxygen therapy, in three different modalities. Multiple correspondence analysis was used to verify the discriminative capacity of the defining characteristics and latent class analysis to determine the diagnostic accuracy of them, based on the severity level defined by the ventilatory mode used. Results: in the multiple correspondence analysis, it was demonstrated that the majority of the defining characteristics presented low discriminative capacity and low percentage of explained variance for the two dimensions (diagnoses). Latent class models, separately adjusted for the two diagnoses, presented a worse fit, with sharing of some defining characteristics. Models adjusted by level of severity (ventilation mode) presented better fit and structure of the component defining characteristics. Conclusion: clinical evidence obtained in the present study seems to demonstrate that the set of defining characteristics of the two nursing diagnoses studied fit better in a single construct. PMID:29211196

  5. Transcutaneous carbon dioxide monitoring in spontaneously breathing, nonintubated patients in the early postoperative period.

    Science.gov (United States)

    Fanelli, G; Baciarello, M; Squicciarini, G; Malagutti, G; Zasa, M; Casati, A

    2008-01-01

    The authors investigated the accuracy of transcutaneous capnometry (TcPCO(2)) in estimating arterial blood carbon dioxide partial pressure (PaCO(2)) during spontaneous breathing in patients admitted to our surgical intensive care unit (ICU). Serial TcPCO(2) and PaCO(2) measurements were taken in stable patients undergoing postoperative monitoring after major abdominal, vascular, or thoracic surgery. Patients were enrolled 12 hours after extubation. Exclusion criteria were pulmonary dysfunction, hemodynamic instability, or anemia. Linear regression, mixed models, and Bland-Altman analyses were used to compare accuracy and correlation between the two variables. Data are presented as means (95% confidence intervals). PaCO(2) values ranged between 26 mmHg and 52 mmHg. Mean values for TcPCO(2) and PaCO(2) were 35.3 (33.8-36.8) mmHg and 39.2 (37.6-40.7) (Pbreathing, nonintubated patients in the early postoperative period.

  6. Analysis of ineffective breathing pattern and impaired spontaneous ventilation of adults with oxygen therapy

    Directory of Open Access Journals (Sweden)

    Deborah Hein Seganfredo

    2017-12-01

    Full Text Available ABSTRACT Objective: to analyze the manifestation of the defining characteristics of the nursing diagnoses of ineffective breathing pattern and impaired spontaneous ventilation, of the NANDA International and the defining characteristics identified in the literature for the concept of “ventilation” in adult patients hospitalized in an intensive care unit with use of oxygen therapy. Method: clinical diagnostic validation study, conducted with 626 patients in intensive care using oxygen therapy, in three different modalities. Multiple correspondence analysis was used to verify the discriminative capacity of the defining characteristics and latent class analysis to determine the diagnostic accuracy of them, based on the severity level defined by the ventilatory mode used. Results: in the multiple correspondence analysis, it was demonstrated that the majority of the defining characteristics presented low discriminative capacity and low percentage of explained variance for the two dimensions (diagnoses. Latent class models, separately adjusted for the two diagnoses, presented a worse fit, with sharing of some defining characteristics. Models adjusted by level of severity (ventilation mode presented better fit and structure of the component defining characteristics. Conclusion: clinical evidence obtained in the present study seems to demonstrate that the set of defining characteristics of the two nursing diagnoses studied fit better in a single construct.

  7. Quantifying Aerosol Delivery in Simulated Spontaneously Breathing Patients With Tracheostomy Using Different Humidification Systems With or Without Exhaled Humidity.

    Science.gov (United States)

    Ari, Arzu; Harwood, Robert; Sheard, Meryl; Alquaimi, Maher Mubarak; Alhamad, Bshayer; Fink, James B

    2016-05-01

    Aerosol and humidification therapy are used in long-term airway management of critically ill patients with a tracheostomy. The purpose of this study was to determine delivery efficiency of jet and mesh nebulizers combined with different humidification systems in a model of a spontaneously breathing tracheotomized adult with or without exhaled heated humidity. An in vitro model was constructed to simulate a spontaneously breathing adult (tidal volume, 400 mL; breathing frequency, 20 breaths/min; inspiratory-expiratory ratio, 1:2) with a tracheostomy using a teaching manikin attached to a test lung through a collecting filter (Vital Signs Respirgard II). Exhaled heat and humidity were simulated using a cascade humidifier set to deliver 37°C and >95% relative humidity. Albuterol sulfate (2.5 mg/3 mL) was administered with a jet nebulizer (AirLife Misty Max) operated at 10 L/min and a mesh nebulizer (Aeroneb Solo) using a heated pass-over humidifier, unheated large volume humidifier both at 40 L/min output and heat-and-moisture exchanger. Inhaled drug eluted from the filter was analyzed via spectrophotometry (276 nm). Delivery efficiency of the jet nebulizer was less than that of the mesh nebulizer under all conditions (P humidity decreased drug delivery up to 44%. The jet nebulizer was less efficient than the mesh nebulizer in all conditions tested in this study. Aerosol deposition with each nebulizer was lowest with the heated humidifier with high flow. Exhaled humidity reduced inhaled dose of drug compared with a standard model with nonheated/nonhumidified exhalation. Further clinical research is warranted to understand the impact of exhaled humidity on aerosol drug delivery in spontaneously breathing patients with tracheostomy using different types of humidifiers. Copyright © 2016 by Daedalus Enterprises.

  8. An evaluation of fresh gas flow rates for spontaneously breathing cats and small dogs on the Humphrey ADE semi-closed breathing system.

    Science.gov (United States)

    Gale, Elizabeth; Ticehurst, Kim E; Zaki, Sanaa

    2015-05-01

    To evaluate the fresh gas flow (FGF) rate requirements for the Humphrey ADE semi-closed breathing system in the Mapleson A mode; to determine the FGF at which rebreathing occurs, and compare the efficiency of this system to the Bain (Mapleson D) system in spontaneously breathing cats and small dogs. Prospective clinical study. Twenty-five healthy (ASA score I or II) client-owned cats and dogs (mean ± SD age 4.7 ± 5.0 years, and body weight 5.64 ± 3.26 kg) undergoing elective surgery or minor procedures. Anaesthesia was maintained with isoflurane delivered via the Humphrey ADE system in the A mode using an oxygen FGF of 100 mL kg(-1) minute(-1). The FGF was then reduced incrementally by 5-10 mL kg(-1) minute(-1) at approximately five-minute intervals, until rebreathing (inspired CO(2) >5 mmHg (0.7 kPa)) was observed, after which flow rates were increased. In six animals, once the minimum FGF at which rebreathing occurred was found, the breathing system was changed to the Bain, and the effects of this FGF delivery examined, before FGF was increased. Rebreathing did not occur at the FGF recommended by the manufacturer for the ADE. The mean ± SD FGF that resulted in rebreathing was 60 ± 20 mL kg(-1) minute(-1). The mean minimum FGF at which rebreathing did not occur with the ADE was 87 ± 39 mL kg(-1) minute(-1). This FGF resulted in significant rebreathing (inspired CO(2) 8.8 ± 2.6 mmHg (1.2 ± 0.3 kPa)) on the Bain system. The FGF rates recommended for the Humphrey ADE are adequate to prevent rebreathing in spontaneously breathing cats and dogs cats and small dogs. © 2014 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

  9. Use of an Impedance Threshold Device in Spontaneously Breathing Patients with Hypotension Secondary to Trauma: An Observational Cohort Feasibility Study

    Science.gov (United States)

    2014-09-09

    hypotension due to multiple causes ; the patients of primary interest experienced a traumatic injury. Upon determination of hypotension (systolic blood...to vasovagal syncope , dehydration, and renal dialysis; (3) provide a treatment of right- sided heart failure after myocardial infarction; and (4...Research, the ITD has been used for treat- ment of hypotension due to multiple causes in spontaneously breathing patients.6,9 The US Army is specifically

  10. Comparison of Size 2 LMA-ProSeal™ and LMA-Supreme™ in Spontaneously Breathing Children: a Randomised Clinical Trial

    OpenAIRE

    Arslan, Zehra İpek; Balcı, Canan; Oysu, Duygu Akalın; Yılmaz, Mehmet; Gürbüz, Necla; İlce, Zekeriya

    2013-01-01

    Objective: The aim of this study was to compare size 2 Laryngeal Mask Airway ProSeal and size 2 Laryngeal Mask Airway Supreme in spontaneously breathing children undergoing lower abdominal elective surgery of <1 hour duration. Study Design: Randomized clinical trial. Material and Methods: Sixty children aged 1-7 years, weighing 10-20 kg, ASA I physical status were randomly allocated to the Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme. Results: There w...

  11. Extracorporeal Carbon Dioxide Removal Enhanced by Lactic Acid Infusion in Spontaneously Breathing Conscious Sheep.

    Science.gov (United States)

    Scaravilli, Vittorio; Kreyer, Stefan; Belenkiy, Slava; Linden, Katharina; Zanella, Alberto; Li, Yansong; Dubick, Michael A; Cancio, Leopoldo C; Pesenti, Antonio; Batchinsky, Andriy I

    2016-03-01

    The authors studied the effects on membrane lung carbon dioxide extraction (VCO2ML), spontaneous ventilation, and energy expenditure (EE) of an innovative extracorporeal carbon dioxide removal (ECCO2R) technique enhanced by acidification (acid load carbon dioxide removal [ALCO2R]) via lactic acid. Six spontaneously breathing healthy ewes were connected to an extracorporeal circuit with blood flow 250 ml/min and gas flow 10 l/min. Sheep underwent two randomly ordered experimental sequences, each consisting of two 12-h alternating phases of ALCO2R and ECCO2R. During ALCO2R, lactic acid (1.5 mEq/min) was infused before the membrane lung. Caloric intake was not controlled, and animals were freely fed. VCO2ML, natural lung carbon dioxide extraction, total carbon dioxide production, and minute ventilation were recorded. Oxygen consumption and EE were calculated. ALCO2R enhanced VCO2ML by 48% relative to ECCO2R (55.3 ± 3.1 vs. 37.2 ± 3.2 ml/min; P less than 0.001). During ALCO2R, minute ventilation and natural lung carbon dioxide extraction were not affected (7.88 ± 2.00 vs. 7.51 ± 1.89 l/min, P = 0.146; 167.9 ± 41.6 vs. 159.6 ± 51.8 ml/min, P = 0.063), whereas total carbon dioxide production, oxygen consumption, and EE rose by 12% each (223.53 ± 42.68 vs. 196.64 ± 50.92 ml/min, 215.3 ± 96.9 vs. 189.1 ± 89.0 ml/min, 67.5 ± 24.0 vs. 60.3 ± 20.1 kcal/h; P less than 0.001). ALCO2R was effective in enhancing VCO2ML. However, lactic acid caused a rise in EE that made ALCO2R no different from standard ECCO2R with respect to ventilation. The authors suggest coupling lactic acid-enhanced ALCO2R with active measures to control metabolism.

  12. Successful protocol of anaesthesia for measuring transepithelial nasal potential difference in spontaneously breathing mice.

    Science.gov (United States)

    Leal, T; Lebacq, J; Vanbinst, R; Lederman, Ch; De Kock, M; Wallemacq, P

    2006-01-01

    Numerous difficulties arise during in vivo measurements of transepithelial nasal potential difference (PD) in mice, such as inadequate duration and depth of anaesthesia, bronchoaspiration of solutions perfused in the nose, and respiratory and/or cardiovascular depression. Anaesthesia was induced in adult C57 mice with intraperitoneal injection of a combination of fentanyl, droperidol and medetomidine, each of these at either a small dose (0.20, 10 and 0.33 mg/kg, respectively) or at a large dose (0.40, 20 and 0.40 mg/kg, respectively), combined with a fixed dose of 0.375 microg clonidine. In order to establish a pharmacokinetic-pharmacodynamic relationship, blood concentrations of the first three drugs were measured in 24 animals by liquid-chromatography tandem mass spectrometry. At the end of the experiment, naloxone, a competitive morphinic antagonist, and atipamezole, an alpha-2 adrenergic antagonist, were administered. Bronchoaspiration was prevented by tilting the animal head downwards and by absorbing the excess fluid from the opposite nostril and from the oral cavity. Optimal assessment of anaesthesia associated with regular respiration, loss of blink, pupillary and pedal withdrawal reflexes was obtained with doses of fentanyl, droperidol and medetomidine corresponding to 0.20, 20 and 0.40 mg/kg, respectively. Blood concentrations of fentanyl around 17 ng/mL induced loss of respiratory efforts and were followed by death during the experiment. Integrity of ion transport was demonstrated under continuous perfusion by successive depolarization after amiloride and repolarization after chloride-free solution. The combination investigated in this study lead to adequate surgical anaesthesia (stage III, plane 2) for prolonged nasal PD measurements in spontaneously breathing mice.

  13. Comparison of objective methods to classify the pattern of respiratory sinus arrhythmia during mechanical ventilation and paced spontaneous breathing

    International Nuclear Information System (INIS)

    Carvalho, N C; Beda, A; Granja-Filho, P; Jandre, F C; Giannella-Neto, A; De Abreu, M G; Spieth, P M

    2009-01-01

    Respiratory sinus arrhythmia (RSA) is a fluctuation of heart period that occurs during a respiratory cycle. It has been suggested that inspiratory heart period acceleration and expiratory deceleration during spontaneous ventilation (henceforth named positive RSA) improve the efficiency of gas exchange compared to the absence or the inversion of such a pattern (negative RSA). During mechanical ventilation (MV), for which maximizing the efficiency of gas exchange is of critical importance, the pattern of RSA is still the object of debate. In order to gain a better insight into this matter, we compared five different methods of RSA classification using the data of five mechanically ventilated piglets. The comparison was repeated using the data of 15 volunteers undergoing a protocol of paced spontaneous breathing, which is expected to result in a positive RSA pattern. The results showed that the agreement between the employed methods is limited, suggesting that the lack of a consensus about the RSA pattern during MV is, at least in part, of methodological origin. However, independently of the method used, the pattern of RSA within the respiratory cycle was not consistent among the subjects and conditions of MV considered. Also, the outcomes showed that even during paced spontaneous breathing a negative RSA pattern might be present, when a low respiratory frequency is imposed

  14. Heart rate variability and stroke volume variability to detect central hypovolemia during spontaneous breathing and supported ventilation in young, healthy volunteers

    International Nuclear Information System (INIS)

    Elstad, Maja; Walløe, Lars

    2015-01-01

    Cardiovascular oscillations exist in many different variables and may give important diagnostic and prognostic information in patients. Variability in cardiac stroke volume (SVV) is used in clinical practice for diagnosis of hypovolemia, but currently is limited to patients on mechanical ventilation. We investigated if SVV and heart rate variability (HRV) could detect central hypovolemia in spontaneously breathing humans: We also compared cardiovascular variability during spontaneous breathing with supported mechanical ventilation.Ten subjects underwent simulated central hypovolemia by lower body negative pressure (LBNP) with >10% reduction of cardiac stroke volume. The subjects breathed spontaneously and with supported mechanical ventilation. Heart rate, respiratory frequency and mean arterial blood pressure were measured. Stroke volume (SV) was estimated by ModelFlow (Finometer). Respiratory SVV was calculated by: 1) SVV% = (SVmax − SVmin)/SVmean during one respiratory cycle, 2) SVIntegral from the power spectra (Fourier transform) at 0.15–0.4 Hz and 3) SVV-norm = (√SVIntegral)/SVmean. HRV was calculated by the same methods.During spontaneous breathing two measures of SVV and all three measures of HRV were reduced during hypovolemia compared to baseline. During spontaneous breathing SVIntegral and HRV% were best to detect hypovolemia (area under receiver operating curve 0.81). HRV% ≤ 11% and SVIntegral ≤ 12 ml 2 differentiated between hypovolemia and baseline during spontaneous breathing.During supported mechanical ventilation, none of the three measures of SVV changed and two of the HRV measures were reduced during hypovolemia. Neither measures of SVV nor HRV were classified as a good detector of hypovolemia.We conclude that HRV% and SVIntegral detect hypovolemia during spontaneous breathing and both are candidates for further clinical testing. (paper)

  15. THE DIFFERENCE IN RESPIRATORY AND BLOOD GAS VALUES DURING RECOVERY AFTER EXERCISE WITH SPONTANEOUS VERSUS REDUCED BREATHING FREQUENCY

    Directory of Open Access Journals (Sweden)

    Jernej Kapus

    2009-09-01

    Full Text Available Extrapolation from post-exercise measurements has been used to estimate respiratory and blood gas parameters during exercise. This may not be accurate in exercise with reduced breathing frequency (RBF, since spontaneous breathing usually follows exercise. This study was performed to ascertain whether measurement of oxygen saturation and blood gases immediately after exercise accurately reflected their values during exercise with RBF. Eight healthy male subjects performed an incremental cycling test with RBF at 10 breaths per minute. A constant load test with RBF (B10 was then performed to exhaustion at the peak power output obtained during the incremental test. Finally, the subjects repeated the constant load test with spontaneous breathing (SB using the same protocol as B10. Pulmonary ventilation (VE, end-tidal oxygen (PETO2, and carbon dioxide pressures (PETCO2 and oxygen saturation (SaO2 were measured during both constant load tests. The partial pressures of oxygen (PO2 and carbon dioxide (PCO2 in capillary blood were measured during the last minute of exercise, immediately following exercise and during the third minute of recovery. At the end of exercise RBF resulted in lower PETO2, SaO2 and PO2, and higher PETCO2 and PCO2 when compared to spontaneous breathing during exercise. Lower SaO2 and PETO2 were detected only for the first 16s and 20s of recovery after B10 compared to the corresponding period in SB. There were no significant differences in PO2 between SB and B10 measured immediately after the exercise. During recovery from exercise, PETCO2 remained elevated for the first 120s in the B10 trial. There were also significant differences between SB and B10 in PCO2 immediately after exercise. We conclude that RBF during high intensity exercise results in hypoxia; however, due to post-exercise hyperpnoea, measurements of blood gas parameters taken 15s after cessation of exercise did not reflect the changes in PO2 and SaO2 seen during

  16. Extracorporeal Gas Exchange and Spontaneous Breathing for the Treatment of Acute Respiratory Distress Syndrome: An Alternative to Mechanical Ventilation?

    Science.gov (United States)

    2014-03-01

    Alveolar minute ventilation (L/min) 5.7 ± 2.7 2.7 ± 1.5 0.003 Dead space fraction 0.44 ± 0.10 0.81 ± 0.10 < 0.001 Pulmonary shunt fraction 0.01 ± 0.01 0.25...ventilation expressed as % of control values, MVALV reduction = reduction in alveolar minute ventilation expressed as percentage of control values...Data are expressed as mean ± sd. Online Laboratory Investigations Critical Care Medicine www.ccmjournal.org e217 of spontaneous breathing: preserved

  17. Tracheostomy as a bridge to spontaneous breathing and awake-ECMO in non-transplant surgical patients.

    Science.gov (United States)

    Swol, J; Strauch, J T; Schildhauer, T A

    2017-05-01

    The tracheostomy is a frequently used procedure for the respiratory weaning of ventilated patients allows sedation free ECLS use in awake patient. The aim of this study is to assess the possibility and highlight the benefits of lowering the impact of sedation in surgical non-transplant patients on ECLS. The specific objective was to investigate the use of tracheostomy as a bridge to spontaneous breathing on ECLS. Of the 95 patients, 65 patients received a tracheostomy, and 5 patients were admitted with a tracheostoma. One patient was cannulated without intubation, one is extubated during ECLS course after 48 hours. 4 patients were extubated after weaning and the removal of ECLS. 19 patients died before the indication to tracheostomy was given. Tracheostomy can bridge to spontaneous breathing and awake-ECMO in non-transplant surgical patients. The "awake ECMO" strategy may avoid complications related to mechanical ventilation, sedation, and immobilization and provide comparable outcomes to other approaches for providing respiratory support. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  18. Comparison of Size 2 LMA-ProSeal™ and LMA-Supreme™ in Spontaneously Breathing Children: a Randomised Clinical Trial

    Directory of Open Access Journals (Sweden)

    Zehra İpek Arslan

    2013-03-01

    Full Text Available Objective: The aim of this study was to compare size 2 Laryngeal Mask Airway ProSeal and size 2 Laryngeal Mask Airway Supreme in spontaneously breathing children undergoing lower abdominal elective surgery of <1 hour duration. Study Design: Randomized clinical trial. Material and Methods: Sixty children aged 1-7 years, weighing 10-20 kg, ASA I physical status were randomly allocated to the Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme. Results: There were no differences in demographic variables, ease of gastric tube placement, ease of insertion and ventilation, number of insertion attempts, hemodynamic changes on insertion, postoperative complications and bloodstaining between the groups. Gastric insufflation was detected and gastric tube was placed in all patients except one in LMA Supreme. Postoperative cuff volumes were comparable with the preoperative values in group itself. Oropharyngeal leak pressures were higher in Laryngeal Mask Airway ProSeal (24.6±5.5 vs 21.3±4.2, respectively; p<0.01. Conclusion: As a result Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme can safely be used in spontaneously breathing pediatric population undergoing lower abdominal elective surgery.

  19. Mapleson′s breathing systems

    Directory of Open Access Journals (Sweden)

    Tej K Kaul

    2013-01-01

    Full Text Available Mapleson breathing systems are used for delivering oxygen and anaesthetic agents and to eliminate carbon dioxide during anaesthesia. They consist of different components: Fresh gas flow, reservoir bag, breathing tubes, expiratory valve, and patient connection. There are five basic types of Mapleson system: A, B, C, D and E depending upon the different arrangements of these components. Mapleson F was added later. For adults, Mapleson A is the circuit of choice for spontaneous respiration where as Mapleson D and its Bains modifications are best available circuits for controlled ventilation. For neonates and paediatric patients Mapleson E and F (Jackson Rees modification are the best circuits. In this review article, we will discuss the structure of the circuits and functional analysis of various types of Mapleson systems and their advantages and disadvantages.

  20. Albuterol Delivery via Facial and Tracheostomy Route in a Model of a Spontaneously Breathing Child.

    Science.gov (United States)

    Cooper, Brandy; Berlinski, Ariel

    2015-12-01

    Some pediatric patients receiving therapeutic aerosols undergo tracheostomy, and others who are tracheostomized continue requiring inhaled therapies upon decannulation. It is unknown whether a dose adjustment is required. Different devices are available for facial and tracheostomy delivery, and in some instances, the assisted technique is used. We hypothesized that the change from face mask to tracheostomy would result in a decrease in the lung dose. A breathing simulator connected in series to a filter holder and an anatomically correct head model of a child was used. The drug captured in the filter was termed the lung dose. Breathing patterns with tidal volumes of 50, 155, and 300 mL were tested. Albuterol hydrofluoroalkane (pressurized metered-dose inhaler [pMDI]) with an AeroChamber Mini (face and 4.5-mm tracheostomy), AeroTrach (4.5-mm tracheostomy), and AeroChamber (face) and albuterol (2.5 mg/3 mL) with a continuous output nebulizer (face and 4.5-mm tracheostomy) were tested. Masks were used for facial delivery. Four units of each device were tested. Particle size of the pMDI was measured by cascade impaction. Albuterol concentration was determined via spectrophotometry (276 nm). Switching from facial to tracheostomy delivery increased lung dose with nebulizer (all breathing patterns). When a pMDI was used, lung dose was unchanged or increased for the 50- and 155-mL and decreased for the 300-mL breathing pattern. The use of the assisted technique increased lung dose only during nebulization with the 300-mL breathing pattern. The particle size of the pMDI decreased by 19-23% when traveling through the tracheostomy tube, which retained tracheostomy was variable and depended on the delivery device and the breathing pattern. There is no advantage of using the assisted technique to enhance aerosol delivery. Copyright © 2015 by Daedalus Enterprises.

  1. Can transcutaneous carbon dioxide pressure be a surrogate of blood gas samples for spontaneously breathing emergency patients? The ERNESTO experience.

    Science.gov (United States)

    Peschanski, Nicolas; Garcia, Léa; Delasalle, Emilie; Mzabi, Lynda; Rouff, Edwin; Dautheville, Sandrine; Renai, Fayrouz; Kieffer, Yann; Lefevre, Guillaume; Freund, Yonathan; Ray, Patrick

    2016-05-01

    It is known that the arterial carbon dioxide pressure (PaCO2) is useful for emergency physicians to assess the severity of dyspnoeic spontaneously breathing patients. Transcutaneous carbon dioxide pressure (PtcCO2) measurements could be a non-invasive alternative to PaCO2 measurements obtained by blood gas samples, as suggested in previous studies. This study evaluates the reliability of a new device in the emergency department (ED). We prospectively included patients presenting to the ED with respiratory distress who were breathing spontaneously or under non-invasive ventilation. We simultaneously performed arterial blood gas measurements and measurement of PtcCO2 using a sensor placed either on the forearm or the side of the chest and connected to the TCM4 CombiM device. The agreement between PaCO2 and PtcCO2 was assessed using the Bland-Altman method. Sixty-seven spontaneously breathing patients were prospectively included (mean age 70 years, 52% men) and 64 first measurements of PtcCO2 (out of 67) were analysed out of the 97 performed. Nineteen patients (28%) had pneumonia, 19 (28%) had acute heart failure and 19 (28%) had an exacerbation of chronic obstructive pulmonary disease. Mean PaCO2 was 49 mm Hg (range 22-103). The mean difference between PaCO2 and PtcCO2 was 9 mm Hg (range -47 to +54) with 95% limits of agreement of -21.8 mm Hg and 39.7 mm Hg. Only 36.3% of the measurement differences were within 5 mm Hg. Our results show that PtcCO2 measured by the TCM4 device could not replace PaCO2 obtained by arterial blood gas analysis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Rapid cerebral vasodilatation in brief hypoxia in anaesthetized animals.

    Science.gov (United States)

    Jennett, S; Pitts, L H; North, J B

    1981-10-01

    In anaesthetized dogs, cats and rabbits, intracranial pressure was measured continuously during brief or transient hypoxia, induced by (a) lowering inspired O2 to 9--10% for 2--3 min, or (b) giving 2--3 breaths of nitrogen. In almost all instances there was an increase in i.c.p. which started in less than 20 s; this occurred with either spontaneous or controlled ventilation, and whether or not there was also a rise in arterial blood pressure; the time course was similar to that of the arterial chemoreceptor reflex responses of ventilation and blood pressure. Division bilaterally of the sinus and vagus nerves in six cats showed that the intracranial pressure response was not dependent on these chemoreceptor afferent pathways. The results suggest a rapid vasodilatation starting at a time when cerebral arterial oxygen tension is unlikely to be below 7 kPa (50 mmHg). The mechanism remains unexplained.

  3. Agreement between values for arterial and end-tidal partial pressures of carbon dioxide in spontaneously breathing, critically ill dogs.

    Science.gov (United States)

    Kelmer, Efrat; Scanson, Lindsey C; Reed, Ann; Love, Lydia C

    2009-12-01

    To determine agreement between arterial partial pressures of carbon dioxide (PaCO(2)) and end-tidal partial pressures of carbon dioxide (PETCO(2)) measured with a nasal catheter in spontaneously breathing, critically ill dogs. Validation study. 26 client-owned dogs admitted to an intensive care unit for various conditions. PaCO(2) was measured with a commercial blood gas analyzer, and PETCO(2) was measured with a sidestream capnograph attached to a nasal catheter. Measurements were obtained twice (ie, with and without supplemental oxygen). Paired values were compared by means of the Pearson correlation method. Level of agreement was assessed by means of the Bland-Altman method. Mean difference between PaCO(2) and PETCO(2) when dogs did not receive supplemental oxygen (mean +/- SD, 3.95 +/- 4.92 mm Hg) was significantly lower than mean difference when dogs did receive supplemental oxygen (6.87 +/- 6.42 mm Hg). Mean difference in dogs with a condition affecting the respiratory system (8.55 +/- 5.43 mm Hg) was significantly higher than mean difference in dogs without respiratory tract disease (3.28 +/- 3.23 mm Hg). There was a significant linear correlation and good agreement between measured values of PaCO(2) and PETCO(2). Catheter size, ventilatory status, and outcome were not significantly associated with mean difference between PaCO(2) and PETCO(2). Results suggested that nasal capnography is a clinically relevant method of estimating PaCO(2) in spontaneously breathing, critically ill dogs, but that values should be interpreted with caution in dogs receiving supplemental oxygen and in dogs with conditions affecting the respiratory system.

  4. Imposed Work of Breathing and Breathing Comfort of Nonintubated Volunteers Breathing with Three Portable Ventilators and a Critical Care Ventilator

    National Research Council Canada - National Science Library

    Austin, Paul

    2001-01-01

    .... The purpose of this study was to assess the imposed inspiratory work of breathing and breathing comfort of nonintubated healthy volunteers breathing spontaneously through three portable ventilators...

  5. Delivery of helium–oxygen mixture during spontaneous breathing: evaluation of three high-concentration face masks.

    Science.gov (United States)

    Roche-Campo, Ferran; Vignaux, Laurence; Galia, Fabrice; Lyazidi, Aissam; Vargas, Frédéric; Texereau, Joëlle; Apiou-Sbirlea, Gabriela; Jolliet, Philippe; Brochard, Laurent

    2011-11-01

    To evaluate the efficacy of delivering a mixture of helium and oxygen gas (He–O2) in spontaneous ventilation. Three high oxygen flow reservoir masks were tested: the Heliox21, specifically designed for helium; the Hi-Ox80 mask, with an inspiratory and an expiratory valve; and a standard high-concentration face mask. This prospective randomized crossover study was performed in six healthy volunteers in a laboratory setting. Volunteers breathed a mixture of 78% He/22% O2 through each of the masks under two different breathing conditions (rest and hyperventilation: minute ventilation of 14.9 ± 6.1 and 26.7 ± 8.7 L min(−1), respectively) and four different He–O2 flow rates (7, 10, 12, and 15 L min(−1)). A nasopharyngeal catheter was used to estimate He pharyngeal concentration (Fp [He]) in the airways in order to determine the percentage of contamination with room air (% air cont) at end-expiration. Under all testing conditions, the Hi-Ox80 mask presented a significantly lower % air cont. During resting breathing pattern, a Fp [He] higher than 50% was achieved in 54% of the tests performed with the Hi-Ox80 mask compared to 29% for the Heliox21 mask and only 17% for the standard mask. At hyperventilation, a Fp [He] higher than 50% was achieved in 17% of the tests performed with the Hi-Ox mask compared to 4% for the other two masks. He–O2 administration via the usual high-concentration reservoir masks results in significant dilution by room air. The Hi-Ox80 mask minimized room air contamination and much more frequently achieved a pharyngeal He concentration higher than 50%.

  6. Can baroreflex measurements with spontaneous sequence analysis be improved by also measuring breathing and by standardization of filtering strategies?

    International Nuclear Information System (INIS)

    Hollow, M R; Parkes, M J; Clutton-Brock, T H

    2011-01-01

    Baroreflex sensitivity (BRS) is known to be attenuated by inspiration and all the original BRS methodologies took this into account by measuring only in expiration. Spontaneous sequence analysis (SSA) is a non-invasive clinical tool widely used to estimate BRS in Man but does not take breathing into account. We have therefore modified it to test whether it too can detect inspiratory attenuation. Traditional SSA is also entangled with issues of distinguishing causal from random relationships between blood pressure and heart period and of the optimum choice of data filter settings. We have also tested whether the sequences our modified SSA rejects do behave as random relationships and show the limitations of the absence of filter standardization. SSA was performed on eupneic data from 1 h periods in 20 healthy subjects. Applying SSA traditionally produced a mean BRS of 23 ± 3 ms mmHg −1 . After modification to measure breathing, SSA detected significant inspiratory attenuation (11 ± 1 ms mmHg −1 ), and the mean expiratory BRS was significantly higher (26 ± 5 ms mmHg −1 ). Traditional SSA therefore underestimates BRS by an amount (3 ms mmHg −1 ) as big as the major physiological and clinical factors known to alter BRS. We show that the sequences rejected by SSA do behave like random associations between pressure and period. We also show the minimal effect of the r 2 filter and the biases that some pressure and heart period filters can introduce. We discuss whether SSA might be improved by standardization of filter settings and by also measuring breathing

  7. The reliability and validity of passive leg raise and fluid bolus to assess fluid responsiveness in spontaneously breathing emergency department patients

    DEFF Research Database (Denmark)

    Duus, Nicolaj; Shogilev, Daniel J; Skibsted, Simon

    2015-01-01

    PURPOSE: We investigated the reproducibility of passive leg raise (PLR) and fluid bolus (BOLUS) using the Non-Invasive Cardiac Output Monitor (NICOM; Cheetah Medical, Tel Aviv, Israel) for assessment of fluid responsiveness (FR) in spontaneously breathing emergency department (ED) patients. METHO...

  8. Comparative study of minimal fresh gas flow used in Lack-Plus and Lack’s circuit in spontaneously breathing anesthetized adults

    Directory of Open Access Journals (Sweden)

    Theerapongpakdee S

    2016-11-01

    Full Text Available Sunchai Theerapongpakdee, Thepakorn Sathitkarnmanee, Sirirat Tribuddharat, Siwalai Sucher, Maneerat Thananun, Duangthida Nonlhaopol Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Background: The Lack’s circuit is a co-axial Mapleson A breathing system commonly used in spontaneously breathing anesthetized adults but still requires high fresh gas flow (FGF. The Lack-Plus circuit was invented with the advantage of lower FGF requirement. The authors compared the Lack-Plus and Lack’s circuit for the minimal FGF requirement with no rebreathing in spontaneously breathing anesthetized adults.Methods: This was a randomized crossover study. We enrolled 24 adult patients undergoing supine elective surgery, with a body mass index ≤30 kg/m2 and an American Society of Anesthesiologists physical status I–II. They were randomly allocated to group 1 (LP-L starting with Lack-Plus then switching to Lack’s circuit or group 2 (L-LP (with the reverse pattern. After induction and intubation, anesthesia was maintained with 50% N2O/O2 and desflurane (4%–6% plus fentanyl titration to maintain an optimal respiratory rate between 10 and 16/min. Starting with the first circuit, all the patients were spontaneously breathing with a FGF of 4 L/min for 10 min, gradually decreased by 0.5 L/min every 5 min until FGF was 2.5 L/min. End-tidal CO2, inspired minimum CO2 (ImCO2, mean arterial pressure, and oxygen saturation were recorded until rebreathing (ImCO2 >0 mmHg occurred. The alternate anesthesia breathing circuit was used and the measurements were repeated.Results: The respective minimal FGF at the point of rebreathing for the Lack-Plus and Lack’s circuit was 2.7±0.8 and 3.3±0.5 L/min, respectively, p<0.001. At an FGF of 2.5 L/min, the respective ImCO2 was 1.5±2.0 and 4.2±2.6 mmHg, respectively, p<0.001.Conclusion: The Lack-Plus circuit can be used safely and effectively, and it requires less FGF than Lack

  9. Aerosol delivery during spontaneous breathing with different types of nebulizers- in vitro/ex vivo models evaluation.

    Science.gov (United States)

    Lin, Hui-Ling; Fang, Tien-Pei; Cho, Hui-Sun; Wan, Gwo-Hwa; Hsieh, Meng-Jer; Fink, James B

    2018-02-01

    Nebulizers for spontaneous breathing have been evaluated through different study designs. There are limitations in simulated bench models related to patient and nebulizer factors. The aim of this study was to determine the correlation of inhaled drug mass between in vitro and ex vivo studies by testing aerosol deposition of various types of nebulizers. Ten healthy subjects were recruited to receive aerosol therapy with five nebulizers in random order: 1) a jet nebulizer (JN); 2) a breath-enhanced nebulizer (BEN); 3) a manually triggered nebulizer (MTN), 4) a breath-actuated nebulizer (BAN), and 5) a vibrating mesh nebulizer (VMN) with valved-adapter. A unit dose of salbutamol containing 5 mg in 2.5 mL was placed into the nebulizer and administered for 10 min. For the ex vivo study, minute ventilation of healthy subjects was recorded for 1 min. For the in vitro study a breathing simulator was utilized with adult breathing patterns. Aerosolized drug from the nebulizers and the accessory tubes was captured using inspiratory and expiratory collecting filters. Captured drug was eluted, measured and expressed as inhaled and exhaled mass using spectrophotometry at a wavelength of 276 nm. 10 healthy subjects were recruited, aged 20.8 ± 0.7 years old, with a mean height of 166.2 ± 9.2 cm and weight of 64.7 ± 12.4 kg. There was no significant difference in the inhaled drug dose between the JN and BEN (15.0 ± 1.94% and 17.74 ± 2.65%, respectively, p = .763), yet the inhaled doses were lower than the other three nebulizers (p vivo model (44.0 ± 0.9% and 35.5 ± 6.3% respectively, p = .003), whereas the JN in the ex vivo model resulted in a greater inhaled drug dose (15.0 ± 1.9% for ex vivo vs 11.6 ± 1.6% for in vitro, p = .008). These in vitro/ex vivo model comparisons of nebulizers performance indicated that breath-related nebulizers can be estimated using an in vitro model; however, the JN and VMN delivered

  10. [Is there an appropriate bispectral index for upper gastrointestinal endoscopy in spontaneous breathing in the pediatric patient?].

    Science.gov (United States)

    Alados-Arboledas, F J; Millán-Bueno, M P; Expósito-Montes, J F; Arévalo-Garrido, A; Pérez-Parras, A; de la Cruz-Moreno, J

    2015-03-01

    The bispectral index (BIS) values that predict appropriate anesthetic level to perform an upper gastrointestinal endoscopy in spontaneous breathing are not well established in Pediatrics. The objective of this study is to determine whether it is possible to find an appropriate, less profound, BIS level in the pediatric patient that would enable an upper gastrointestinal endoscopy (UGE) to be performed in spontaneous breathing without causing gag reflex or motor response. A prospective study was designed and included 61 patients from 12-167 months old, and an ASAI-II who needed a diagnostic UGE. The study was conducted from October 2011 to March 2013. UGE performed with an anesthetic protocol using propofol. The vital signs measured were heart and respiratory rate, pulse oximetry, non-invasive blood pressure. The sedation level score (Ramsay scale) and BIS values were also measured. The first attempt was performed at BIS level 60-69, and this was not feasible, then the anesthetic was deepened and a second attempt made at BIS level 50-59. If this was still not possible a deeper anesthetic level was then achieved and a third attempt made at BIS level 45-49. Variables of interest were: effective BIS level (eBIS), BIS level at which UGE was performed without gag reflex or motor response; propofol total dose (mgkg(-1)), induction time (time from onset of sedation to effective start of UGE). A logistic regression analysis was performed to obtain an equation to estimate the possibility of UGE success. The distribution of the patient was: male 40%, female 60%, with 11 (18%) patients under 36 months. The statistical values are expressed as mean and standard deviation, with following results; age (months): 95.9±45.86; weight (kg): 30.5±14.68; effective BIS: 56.41±4.63; induction time (minutes): 11.07±2.69; total propofol dose (per kg): 4.86±1.21. An additional intra-procedure propofol bolus was given in 38 patients (62%), with 7/38 of them (18%) due to movement, and 31

  11. Typical patterns of expiratory flow and carbon dioxide in mechanically ventilated patients with spontaneous breathing.

    Science.gov (United States)

    Rees, S E; Larraza, S; Dey, N; Spadaro, S; Brohus, J B; Winding, R W; Volta, C A; Karbing, D S

    2017-08-01

    Incomplete expiration of tidal volume can lead to dynamic hyperinflation and auto-PEEP. Methods are available for assessing these, but are not appropriate for patients with respiratory muscle activity, as occurs in pressure support. Information may exist in expiratory flow and carbon dioxide measurements, which, when taken together, may help characterize dynamic hyperinflation. This paper postulates such patterns and investigates whether these can be seen systematically in data. Two variables are proposed summarizing the number of incomplete expirations quantified as a lack of return to zero flow in expiration (IncExp), and the end tidal CO 2 variability (varETCO 2 ), over 20 breaths. Using these variables, three patterns of ventilation are postulated: (a) few incomplete expirations (IncExp  18) and small varETCO 2 . IncExp and varETCO 2 were calculated from data describing respiratory flow and CO 2 signals in 11 patients mechanically ventilated at 5 levels of pressure support. Data analysis showed that the three patterns presented systematically in the data, with periods of IncExp  18 having significantly lower variability in end-tidal CO 2 than periods with 2 ≤ IncExp ≤ 18 (p  18 to 2 ≤ IncExp ≤ 18 results in significant, rapid, change in the variability of end-tidal CO 2 p < 0.05. This study illustrates that systematic patterns of expiratory flow and end-tidal CO 2 are present in patients in supported mechanical ventilation, and that changes between these patterns can be identified. Further studies are required to see if these patterns characterize dynamic hyperinflation. If so, then their combination may provide a useful addition to understanding the patient at the bedside.

  12. A new co-axial breathing system. A combination of the benefits of Mapleson A, D and E systems.

    Science.gov (United States)

    Burchett, K R; Bennett, J A

    1985-02-01

    A new, simple, versatile co-axial breathing system combining the features of Mapleson A, D and E type systems is described. The change from an A system to a D/E system is effected by a single switch and without reversal of the gas flow. Fresh gas flows in the order of 70 ml/kg/min are required for both spontaneous ventilation in the Mapleson A mode and controlled ventilation in the Mapleson D mode. The co-axial configuration offers the advantages of a single, lightweight breathing system with easy scavenging of anaesthetic gases, while the ability to switch between the A and D or E configurations offers the economic advantages of low fresh gas flows and the need for a single anaesthetic breathing system for all situations.

  13. Respiratory pattern and rebreathing in the Mapleson A, C and D breathing systems with spontaneous ventilation. A theory.

    Science.gov (United States)

    Cook, L B

    1996-04-01

    A theoretical analysis is presented of the Mapleson A, C and D breathing systems when used in spontaneous respiration. The influence of the respiratory pattern is explained diagrammatically. Simple equations are derived, predicting the fresh gas flow required to prevent rebreathing with different respiratory patterns. Further equations allow the degree of rebreathing caused by inadequate fresh gas flow to be quantified. These are used to examine the effects of different respiratory patterns on the efficiency of the three systems. It is demonstrated that the single most important determinant of efficiency is the duration of the expiratory pause. The nature of the inspiratory and expiratory waveforms is less important and the I:E ratio far less important. The analysis suggests that the Mapleson A system will always be the most efficient of the three systems. The Mapleson C system will be efficient if inspiration is long and the expiratory pause is minimal. The Mapleson D system will be efficient if the expiratory pause is sufficiently long.

  14. Comparison of trapezius squeeze test and jaw thrust as clinical indicators for laryngeal mask airway insertion in spontaneously breathing children.

    Science.gov (United States)

    Dinesh Kumar, K K; Bhardwaj, Neerja; Yaddanapudi, Sandhya

    2017-01-01

    It is not known whether trapezius squeeze test (TPZ) is a better clinical test than jaw thrust (JT) to assess laryngeal mask airway (LMA) insertion conditions in children under sevoflurane anesthesia. After the Institutional Ethics Committee approval and written informed parental consent, 124 American Society of Anesthesiologists I and II children of 2-8 years of age undergoing minor surgical procedures were randomized into TPZ and JT groups. The children were induced with 8% sevoflurane in oxygen at a fresh gas flow of 4 L/min. TPZ or JT was performed after 1 min of start of sevoflurane and then every 20 s till the test was negative, when end-tidal (ET) sevoflurane concentration was noted. Classic LMA of requisite size was inserted by a blinded anesthetist and conditions at the insertion of LMA, insertion time, and the number of attempts of LMA insertion were recorded. The mean LMA insertion time was significantly longer ( P insertion was comparable in the two groups. LMA insertion conditions were similar in the two groups. There was no difference between the two groups regarding total number of attempts of LMA insertion. Heart rate (HR) decreased in both groups after LMA insertion ( P insertion ( P = 0.03). Both JT and TPZ are equivalent clinical indicators in predicting the optimal conditions of LMA insertion in spontaneously breathing children; however, it takes a longer time to achieve a negative TPZ squeeze test.

  15. Combination of intravenous dexmedetomidine with topicalization of airway for placement of double lumen tube in a spontaneously breathing patient of giant lung bullae

    Directory of Open Access Journals (Sweden)

    Vikas Karne

    2016-10-01

    Here we present a patient with giant lung bulla in left lower lobe with severely reduced pulmonary reserves and significant air-trapping posted for VAT assisted bullectomy. Anaesthesia challenges including pathological changes, its effects during induction of anaesthesia, and issues related to placement of double lumen tube in a spontaneously breathing patient are discussed with possible advantages of dexmedetomidine in this special group of patients.

  16. Randomised Comparison of the AMBU AuraOnce Laryngeal Mask and the LMA Unique Laryngeal Mask Airway in Spontaneously Breathing Adults

    OpenAIRE

    Williams, Daryl Lindsay; Zeng, James M.; Alexander, Karl D.; Andrews, David T.

    2012-01-01

    We conducted a randomised single-blind controlled trial comparing the LMA-Unique (LMAU) and the AMBU AuraOnce (AMBU) disposable laryngeal mask in spontaneously breathing adult patients undergoing general anaesthesia. Eighty-two adult patients (ASA status I–IV) were randomly allocated to receive the LMAU or AMBU and were blinded to device selection. Patients received a standardized anesthetic and all airway devices were inserted by trained anaesthetists. Size selection was guided by manufactur...

  17. Comparative study of minimal fresh gas flow used in Lack-Plus and Lack’s circuit in spontaneously breathing anesthetized adults

    Science.gov (United States)

    Theerapongpakdee, Sunchai; Sathitkarnmanee, Thepakorn; Tribuddharat, Sirirat; Sucher, Siwalai; Thananun, Maneerat; Nonlhaopol, Duangthida

    2016-01-01

    Background The Lack’s circuit is a co-axial Mapleson A breathing system commonly used in spontaneously breathing anesthetized adults but still requires high fresh gas flow (FGF). The Lack-Plus circuit was invented with the advantage of lower FGF requirement. The authors compared the Lack-Plus and Lack’s circuit for the minimal FGF requirement with no rebreathing in spontaneously breathing anesthetized adults. Methods This was a randomized crossover study. We enrolled 24 adult patients undergoing supine elective surgery, with a body mass index ≤30 kg/m2 and an American Society of Anesthesiologists physical status I–II. They were randomly allocated to group 1 (LP-L) starting with Lack-Plus then switching to Lack’s circuit or group 2 (L-LP) (with the reverse pattern). After induction and intubation, anesthesia was maintained with 50% N2O/O2 and desflurane (4%–6%) plus fentanyl titration to maintain an optimal respiratory rate between 10 and 16/min. Starting with the first circuit, all the patients were spontaneously breathing with a FGF of 4 L/min for 10 min, gradually decreased by 0.5 L/min every 5 min until FGF was 2.5 L/min. End-tidal CO2, inspired minimum CO2 (ImCO2), mean arterial pressure, and oxygen saturation were recorded until rebreathing (ImCO2 >0 mmHg) occurred. The alternate anesthesia breathing circuit was used and the measurements were repeated. Results The respective minimal FGF at the point of rebreathing for the Lack-Plus and Lack’s circuit was 2.7±0.8 and 3.3±0.5 L/min, respectively, p<0.001. At an FGF of 2.5 L/min, the respective ImCO2 was 1.5±2.0 and 4.2±2.6 mmHg, respectively, p<0.001. Conclusion The Lack-Plus circuit can be used safely and effectively, and it requires less FGF than Lack’s circuit in spontaneously breathing anesthetized adults. PMID:27877068

  18. Development, implementation, and evaluation of an institutional daily awakening and spontaneous breathing trial protocol: a quality improvement project.

    Science.gov (United States)

    Kher, Sucharita; Roberts, Russel J; Garpestad, Erik; Kunkel, Chris; Howard, William; Didominico, Dorothy; Fergusson, Anne; Devlin, John W

    2013-01-01

    While one controlled trial found that a daily awakening and spontaneous breathing trial (DA-SBT) decreases time on mechanical ventilation (MV), there is a paucity of real-world data surrounding the development, implementation, and impact of DA-SBT protocols. We describe a multidisciplinary process improvement effort in 2, 10-bed medical intensive care units (MICUs) at a 330-bed academic medical center that focused on the development, implementation, and evaluation of a new DA-SBT protocol. A DA-SBT protocol, developed using results from a nursing survey literature and available institutional resources, was implemented after extensive clinician education and institution of quality reminders to boost use. Postprotocol compliance was evaluated. Use of sedation, DA and SBT practices, and clinical outcomes were retrospectively compared between the before and after DA-SBT protocol groups (ie, consecutive MICU patients requiring a continuously infused sedative [CIS] ≥24 hours). In the after group (n = 32), the DA and SBT compliances were 44% and 84%, respectively. Compared with the before group (n = 33), after group patients received CIS on fewer days of MV (100% vs 67%, P = .003) and had their CIS down-titrated by ≥25% on more days of CIS (40% vs 71%, P = .006). Neither total CIS dose (P = .49), total MV days (P = .75), days of MV where a SBT occurred (P = .38), nor episodes of self-extubation (15% vs 6%, P = .43) differed between the 2 groups. Despite the implementation of a DA-SBT protocol that was individualized to clinician preferences and institutional resources and accompanied by substantial education and reminders for use, compliance to the DA component of this protocol was low and duration of MV remained unchanged. Additional quality improvement strategies are needed to overcome barriers to DA-SBT protocol use that may not exist in controlled clinical trials.

  19. Spontaneous breathing with biphasic positive airway pressure attenuates lung injury in hydrochloric acid-induced acute respiratory distress syndrome.

    Science.gov (United States)

    Xia, Jingen; Zhang, Heng; Sun, Bing; Yang, Rui; He, Hangyong; Zhan, Qingyuan

    2014-06-01

    It has been proved that spontaneous breathing (SB) with biphasic positive airway pressure (BIPAP) can improve lung aeration in acute respiratory distress syndrome compared with controlled mechanical ventilation. The authors hypothesized that SB with BIPAP would attenuate lung injury in acute respiratory distress syndrome compared with pressure-controlled ventilation. Twenty male New Zealand white rabbits with hydrochloric acid aspiration-induced acute respiratory distress syndrome were randomly ventilated using the BIPAP either with SB (BIPAP plus SB group) or without SB (BIPAP minus SB group) for 5 h. Inspiration pressure was adjusted to maintain the tidal volume at 6 ml/kg. Both groups received the same positive end-expiratory pressure level at 5 cm H2O for hemodynamic goals. Eight healthy animals without ventilatory support served as the control group. The BIPAP plus SB group presented a lower ratio of dead space ventilation to tidal volume, a lower respiratory rate, and lower minute ventilation. No significant difference in the protein levels of interleukin-6 and interleukin-8 in plasma, bronchoalveolar lavage fluid, and lung tissue were measured between the two experimental groups. However, SB resulted in lower messenger ribonucleic acid levels of interleukin-6 (mean ± SD; 1.8 ± 0.7 vs. 2.6 ± 0.5; P = 0.008) and interleukin-8 (2.2 ± 0.5 vs. 2.9 ± 0.6; P = 0.014) in lung tissues. In addition, lung histopathology revealed less injury in the BIPAP plus SB group (lung injury score, 13.8 ± 4.6 vs. 21.8 ± 5.7; P hydrochloric acid-induced acute respiratory distress syndrome, SB with BIPAP attenuated lung injury and improved respiratory function compared with controlled ventilation with low tidal volume.

  20. A novel approach using time-frequency analysis of pulse-oximeter data to detect progressive hypovolemia in spontaneously breathing healthy subjects.

    Science.gov (United States)

    Selvaraj, Nandakumar; Shelley, Kirk H; Silverman, David G; Stachenfeld, Nina; Galante, Nicholas; Florian, John P; Mendelson, Yitzhak; Chon, K

    2011-08-01

    Accurate and early detection of blood volume loss would greatly improve intraoperative and trauma care. This study has attempted to determine early diagnostic and quantitative markers for blood volume loss by analyzing photoplethysmogram (PPG) data from ear, finger and forehead sites with our high-resolution time-frequency spectral (TFS) technique in spontaneously breathing healthy subjects (n = 11) subjected to lower body negative pressure (LBNP). The instantaneous amplitude modulations present in heart rate (AM HR) and breathing rate (AMBR) band frequencies of PPG signals were calculated from the high-resolution TFS. Results suggested that the changes (P signals, respectively. The mean percent increase in AMBR values at 100% LBNP tolerance was 99.4% and 19.6% for ear and finger sites, respectively; AMBR values were not attainable for forehead PPG signal. Even without baseline AMHR values, our results suggest that hypovolemia detection is possible with specificity and sensitivity greater than 90% for the ear and forehead locations when LBNP tolerance is 100%. Therefore, the TFS analysis of noninvasive PPG waveforms is promising for early diagnosis and quantification of hypovolemia at levels not identified by vital signs in spontaneously breathing subjects.

  1. Spontaneous breathing trial in T-tube negatively impact on autonomic modulation of heart rate compared with pressure support in critically ill patients.

    Science.gov (United States)

    Güntzel Chiappa, Adriana M; Chiappa, Gaspar R; Cipriano, Gerson; Moraes, Ruy S; Ferlin, Elton L; Borghi-Silva, Audrey; Vieira, Silvia R

    2017-07-01

    Spontaneous breathing with a conventional T-piece (TT) connected to the tracheal tube orotraqueal has been frequently used in clinical setting to weaning of mechanical ventilation (MV), when compared with pressure support ventilation (PSV). However, the acute effects of spontaneous breathing with TT versus PSV on autonomic function assessed through heart rate variability (HRV) have not been fully elucidated. The purpose of this study was to examine the acute effects of spontaneous breathing in TT vs PSV in critically ill patients. Twenty-one patients who had received MV for ≥ 48 h and who met the study inclusion criteria for weaning were assessed. Eligible patients were randomized to TT and PSV. Cardiorespiratory responses (respiratory rate -ƒ, tidal volume-V T , mean blood pressure (MBP) and diastolic blood pressure (DBP), end tidal dioxide carbone (P ET CO 2 ), peripheral oxygen saturation (SpO 2 ) and HRV indices in frequency domain (low-LF, high frequency (HF) and LF/HF ratio were evaluated. TT increased ƒ (20 ± 5 vs 25 ± 4 breaths/min, P<0.05), MBP (90 ± 14 vs 94 ± 18 mmHg, P<0.05), HR (90 ± 17 vs 96 ± 12 beats/min, P<0.05), P ET CO 2 (33 ± 8 vs 48 ± 10 mmHg, P<0.05) and reduced SpO 2 (98 ± 1.6 vs 96 ± 1.6%, P<0.05). In addition, LF increased (47 ± 18 vs 38 ± 12 nu, P<0.05) and HF reduced (29 ± 13 vs 32 ± 16 nu, P<0.05), resulting in higher LF/HF ratio (1.62 ± 2 vs 1.18 ± 1, P<0.05) during TT. Conversely, V T increased with PSV (0.58 ± 0.16 vs 0.50 ± 0.15 L, P<0.05) compared with TT. Acute effects of TT mode may be closely linked to cardiorespiratory mismatches and cardiac autonomic imbalance in critically ill patients. © 2015 John Wiley & Sons Ltd.

  2. Electrically-activated dilator muscles reduce pharyngeal resistance in anaesthetized dogs with upper airway obstruction.

    Science.gov (United States)

    Bishara, H; Odeh, M; Schnall, R P; Gavriely, N; Oliven, A

    1995-09-01

    There is current controversy as to whether electrical stimulation of upper airway musculature can be used us a beneficial treatment modality in patients with obstructive sleep apnoea syndrome. Increased upper airway (UAW) muscle activity decreases UAW resistance (Ruaw) in isolated UAW of dogs. In the present study, we evaluated the effect of UAW muscle contraction on UAW patency in anaesthetized dogs in vivo breathing spontaneously through partially and completely obstructed UAW. Airflow and supraglottic pressure were measured to obtain Ruaw. Ruaw could be regulated by inhalation of a rubber balloon implanted transcutaneously in the pharyngeal submucosa to produce partial or complete obstruction. Wire electrodes were implanted bilaterally into the genioglossus (GG), geniohyoid (GH), sternothyroid (ST), and sternohyoid (SH) muscles for electrical stimulation (ES), and into the alae nasi for electromyographic (EMG) recording. Three levels of electrical stimulation were delivered to each muscle before and during partial or complete UAW obstruction. Genioglossus and geniohyoid stimulation both resulted in a significant reduction in Ruaw, which was most pronounced during partial obstruction, reducing Ruaw from 54 +/- 11 to 14 +/- 3 and from 74 +/- 12 to 31 +/- 5 cmH2O.L-1.s, respectively. At low voltage, stimulation of the genioglossus was more effective than stimulation of the geniohyoid in reducing Ruaw. Furthermore, electrical stimulation of the genioglossus but not of the geniohyoid released total obstruction. In contrast, electrical stimulation of the sternohyoid and sternothyroid produced no significant change in Ruaw. These findings demonstrate that selective UAW dilatory muscle contraction in spontaneously breathing anaesthetized dogs reduces Ruaw in the presence of UAW obstruction and releases UAW occlusion, with the genioglossus being the most effective muscle. This favours further attempts to investigate the benefits of electrical stimulation of selected

  3. Tuberous sclerosis Anaesthetic considerations

    African Journals Online (AJOL)

    QuickSilver

    SYNDROMIC VIGNETTES IN ANAESTHESIA. Southern African Journal of Anaesthesia & Analgesia - May 2003. 4. Tuberous sclerosis. Anaesthetic considerations. Tuberous sclerosis. Tuberous sclerosis(TS) was first described by Bourneville in. 1880.1 TS is said to be one of the commonest autosomal domi- nant diseases.

  4. Intermittent hypoxia-induced respiratory long-term facilitation is dominated by enhanced burst frequency, not amplitude, in spontaneously breathing urethane-anesthetized neonatal rats.

    Science.gov (United States)

    Reid, Inefta M; Solomon, Irene C

    2014-01-01

    Acute intermittent hypoxia (AIH) triggers a form of respiratory plasticity known as long-term facilitation (LTF), which is manifested as a progressive increase in respiratory motor activity that lasts for minutes to hours after the hypoxic stimulus is removed. Respiratory LTF has been reported in numerous animal models, but it appears to be influenced by a variety of factors (e.g., species, age, and gender). While most studies focusing on respiratory LTF have been conducted in adult (including young adult) rat preparations, little is known about the influence of postnatal maturation on AIH-induced respiratory LTF. To begin to address this issue, we examined diaphragm EMG activity in response to and at 5-min intervals for 60 min following three 5-min episodes of hypoxia (8% O2) in urethane-anesthetized spontaneously breathing P14-P15 neonatal rats (n=15). For these experiments, the hypoxic episodes were separated by hyperoxia (40% O2), and all rats were continuously supplied with ~4% CO2. During the AIH trials, burst frequency was increased by ~20-90% above baseline in each of the rats examined while changes in burst amplitude were highly variable. Following the AIH episodes, respiratory LTF was characterized by predominantly an increase in burst frequency (fLTF) ranging from ~10% to 55%, with most rats exhibiting a 20-40% increase. In seven rats, however, an increase in amplitude (ampLTF) (~10%, n=3; ~20%, n=3; ~30%, n=1) was also noted. These data suggest that in contrast to observations in anesthetized ventilated adult rats, in anesthetized spontaneously breathing P14-P15 neonatal rats, respiratory LTF is dominated by fLTF, not ampLTF. © 2014 Elsevier B.V. All rights reserved.

  5. Monitoring volatile anaesthetic agents

    International Nuclear Information System (INIS)

    Russell, W.J.

    2000-01-01

    Full text: The methods that have been used for monitoring volatile anaesthetic agents depend on some physical property such as Density, Refractometry, Mass, Solubility, Raman scattering, or Infra-red absorption. Today, refractometry and infra-red techniques are the most common. Refractometry is used for the calibration of vaporizers. All anaesthetic agents increase the refractive index of the carrier gas. Provided the mixture is known then the refractive change measures the concentration of the volatile anaesthetic agent. Raman Scattering is when energy hits a molecule a very small fraction of the energy is absorbed and re-emitted at one or more lower frequencies. The shift in frequency is a function of the chemical bonds and is a fingerprint of the substance irradiated. Electromagnetic (Infra-red) has been the commonest method of detection of volatile agents. Most systems use a subtractive system, i.e. the agent in the sampling cell absorbed some of the infrared energy and the photo-detector therefore received less energy. A different approach is where the absorbed energy is converted into a pressure change and detected as sound (Acoustic monitor). This gives a more stable zero reference. More recently, the detector systems have used multiple narrow-band wavelengths in the infrared bands and by shape matching or matrix computing specific agent identification is achieved and the concentration calculated. In the early Datex AS3 monitors, a spectral sweep across the 3 micron infrared band was used to create spectral fingerprints. The recently released AS3 monitors use a different system with five very narrow band filters in the 8-10 micron region. The transmission through each of these filters is a value in a matrix which is solved by a micro computer to identify the agent and its concentration. These monitors can assist in improving the safety and efficiency of our anaesthetics but do not ensure that the patient is completely anaesthetized. Copyright (2000

  6. Comparison of alfaxalone, ketamine and thiopental for anaesthetic induction and recovery in Thoroughbred horses premedicated with medetomidine and midazolam.

    Science.gov (United States)

    Wakuno, A; Aoki, M; Kushiro, A; Mae, N; Kodaira, K; Maeda, T; Yamazaki, Y; Ohta, M

    2017-01-01

    There is limited information on clinical use of the new injectable anaesthetic agent alfaxalone in Thoroughbred horses. To compare anaesthetic induction and recovery characteristics and cardiopulmonary responses between alfaxalone, ketamine and thiopental in Thoroughbred horses premedicated with medetomidine and midazolam. Randomised blinded experimental cross-over study. Six Thoroughbred horses were anaesthetised 3 times with alfaxalone 1 mg/kg bwt, ketamine 2.5 mg/kg bwt or thiopental 4 mg/kg bwt after premedication with medetomidine 6 μg/kg bwt and midazolam 20 μg/kg bwt. Qualities of anaesthetic induction and recovery were scored on a scale of 1 (poor) to 5 (excellent). Induction time and recovery time were recorded. Cardiopulmonary values (heart rate, respiratory rate, arterial blood pressures, and arterial blood gases) were recorded throughout anaesthesia. Data were analysed with nonparametric methods. The anaesthetic induction (P = 0.2) and recovery (P = 0.1) quality scores (median, range) were not different amongst protocols and were 4.0, 3-5; 5.0, 4-5; 4.5, 3-5; and 4.5, 3-5; 3.5, 2-5; 4.0, 2-5 for alfaxalone, ketamine and thiopental, respectively. Induction time for ketamine (67, 53-89 s) was significantly longer than that for alfaxalone (49, 40-51 s, P = 0.01) and thiopental (48, 43-50 s, P = 0.01). Time to standing for alfaxalone (44, 40-63 min, P = 0.01) and thiopental (39, 30-58 min, P = 0.01) was significantly longer than that for ketamine (25, 18-26 min). Cardiovascular values were maintained within the clinically acceptable level throughout anaesthesia. Respiratory rate significantly decreased during anaesthesia for all 3 drugs; however, spontaneous breathing did not disappear, and PaCO 2 values were maintained at approximately 50 mmHg. All 3 drugs showed similar effects in relation to anaesthetic induction and recovery qualities and cardiopulmonary responses. However, alfaxalone and thiopental prolonged recovery time

  7. Hemorrhagic shock-induced endothelial cell activation in a spontaneous breathing and a mechanical ventilation hemorrhagic shock model is induced by a proinflammatory response and not by hypoxia.

    Science.gov (United States)

    van Meurs, Matijs; Wulfert, Francis M; Jongman, Rianne M; Schipper, Martin; Houwertjes, Martin C; Vaneker, Michiel; Scheffer, Gert Jan; Teppema, Luc J; Aarts, Leon P H J; Heeringa, Peter; Zijlstra, Jan G; Molema, Grietje

    2011-09-01

    The interaction between neutrophils and activated endothelium is essential for the development of multiple organ dysfunction in patients with hemorrhagic shock (HS). Mechanical ventilation frequently is used in patients with HS. The authors sought to investigate the consequences of mechanical ventilation of mice subjected to HS on microvascular endothelial activation in the lung and kidney. Anesthetized wild type C57BL/6 male mice were subjected to controlled hemorrhage; subgroups of mice were mechanically ventilated during the HS insult. To study the effect of acute hypoxia on the mice, the animals were housed in hypoxic cages. Gene expression levels was assessed by quantitative real-time polymerase chain reaction. Protein expression was assessed by immunohistochemistry and enzyme-linked immunosorbent assay. Ninety minutes after the shock induction, a vascular bed-specific, heterogeneous proinflammatory endothelial activation represented by E-selectin, vascular cell adhesion molecule 1, and intercellular adhesion molecule 1 expression was seen in kidney and lung. No differences in adhesion molecules between the spontaneously breathing and mechanically ventilated mice were found. Concentrations of the proinflammatory cytokines chemokine (C-X-C motif) ligand 1 (11.0-fold) and interleukin-6 (21.7-fold) were increased after 90 min of HS. Two hours of 6% oxygen did not induce the expression of E-selectin, vascular cell adhesion molecule 1, and intercellular adhesion molecule 1 in the kidneys and the lung. Hemorrhagic shock leads to an early and reversible proinflammatory endothelial activation in kidney and lung. HS-induced endothelial activation is not changed by mechanical ventilation during the shock phase. Hypoxia alone does not lead to endothelial activation. The observed proinflammatory endothelial activation is mostly ischemia- or reperfusion-dependent and not related to hypoxia.

  8. Effects of reduced rebreathing time, in spontaneously breathing patients, on respiratory effort and accuracy in cardiac output measurement when using a partial carbon dioxide rebreathing technique: a prospective observational study.

    Science.gov (United States)

    Tachibana, Kazuya; Imanaka, Hideaki; Takeuchi, Muneyuki; Nishida, Tomoyo; Takauchi, Yuji; Nishimura, Masaji

    2005-10-05

    New technology using partial carbon dioxide rebreathing has been developed to measure cardiac output. Because rebreathing increases respiratory effort, we investigated whether a newly developed system with 35 s rebreathing causes a lesser increase in respiratory effort under partial ventilatory support than does the conventional system with 50 s rebreathing. We also investigated whether the shorter rebreathing period affects the accuracy of cardiac output measurement. Once a total of 13 consecutive post-cardiac-surgery patients had recovered spontaneous breathing under pressure support ventilation, we applied a partial carbon dioxide rebreathing technique with rebreathing of 35 s and 50 s in a random order. We measured minute ventilation, and arterial and mixed venous carbon dioxide tension at the end of the normal breathing period and at the end of the rebreathing periods. We then measured cardiac output using the partial carbon dioxide rebreathing technique with the two rebreathing periods and using thermodilution. With both rebreathing systems, minute ventilation increased during rebreathing, as did arterial and mixed venous carbon dioxide tensions. The increases in minute ventilation and arterial carbon dioxide tension were less with 35 s rebreathing than with 50 s rebreathing. The cardiac output measures with both systems correlated acceptably with values obtained with thermodilution. When patients breathe spontaneously the partial carbon dioxide rebreathing technique increases minute ventilation and arterial carbon dioxide tension, but the effect is less with a shorter rebreathing period. The 35 s rebreathing period yielded cardiac output measurements similar in accuracy to those with 50 s rebreathing.

  9. Effect of body position on the arterial partial pressures of oxygen and carbon dioxide in spontaneously breathing, conscious dogs in an intensive care unit.

    Science.gov (United States)

    McMillan, Matthew W; Whitaker, Katie E; Hughes, Dez; Brodbelt, David C; Boag, Amanda K

    2009-12-01

    To evaluate the effect of body position on the arterial partial pressures of oxygen and carbon dioxide (PaO(2), PaCO(2)), and the efficiency of pulmonary oxygen uptake as estimated by alveolar-arterial oxygen difference (A-a difference). Prospective, randomized, crossover study. University teaching hospital, intensive care unit. Twenty-one spontaneously breathing, conscious, canine patients with arterial catheters placed as part of their management strategy. Patients were placed randomly into lateral or sternal recumbency. PaO(2) and PaCO(2) were measured after 15 minutes in this position. Patients were then repositioned into the opposite position and after 15 minutes the parameters were remeasured. Results presented as median (interquartile range). PaO(2) was significantly higher (P=0.001) when patients were positioned in sternal, 91.2 mm Hg (86.0-96.1 mm Hg), compared with lateral recumbency, 86.4 mm Hg (73.9-90.9 mm Hg). The median change was 5.4 mm Hg (1.1-17.9 mm Hg). All 7 dogs with a PaO(2)<80 mm Hg in lateral recumbency had improved arterial oxygenation in sternal recumbency, median increase 17.4 mm Hg with a range of 3.8-29.7 mm Hg. PaCO(2) levels when patients were in sternal recumbency, 30.5 mm Hg (27.3-32.7 mm Hg) were not significantly different from those in lateral recumbency, 32.2 mm Hg (28.3-36.0 mm Hg) (P=0.07). The median change was -1.9 mm Hg (-3.6-0.77 mm Hg). A-a differences were significantly lower (P=0.005) when patients were positioned in sternal recumbency, 21.7 mm Hg (17.3-27.7 mm Hg), compared with lateral recumbency, 24.6 mm Hg (20.4-36.3 mm Hg). The median change was -3.1 mm Hg (-14.6-0.9 mm Hg). PaO(2) was significantly higher when animals were positioned in sternal recumbency compared with lateral recumbency, predominantly due to improved pulmonary oxygen uptake (decreased A-a difference) rather than increased alveolar ventilation (decreased PaCO(2)). Patients with hypoxemia (defined as PaO(2)<80 mm Hg) in lateral recumbency may

  10. Effects of ultraprotective ventilation, extracorporeal carbon dioxide removal, and spontaneous breathing on lung morphofunction and inflammation in experimental severe acute respiratory distress syndrome.

    Science.gov (United States)

    Güldner, Andreas; Kiss, Thomas; Bluth, Thomas; Uhlig, Christopher; Braune, Anja; Carvalho, Nadja; Quast, Theresa; Rentzsch, Ines; Huhle, Robert; Spieth, Peter; Richter, Torsten; Saddy, Felipe; Rocco, Patricia R M; Kasper, Michael; Koch, Thea; Pelosi, Paolo; de Abreu, Marcelo Gama

    2015-03-01

    To investigate the role of ultraprotective mechanical ventilation (UP-MV) and extracorporeal carbon dioxide removal with and without spontaneous breathing (SB) to improve respiratory function and lung protection in experimental severe acute respiratory distress syndrome. Severe acute respiratory distress syndrome was induced by saline lung lavage and mechanical ventilation (MV) with higher tidal volume (VT) in 28 anesthetized pigs (32.8 to 52.5 kg). Animals (n = 7 per group) were randomly assigned to 6 h of MV (airway pressure release ventilation) with: (1) conventional P-MV with VT ≈6 ml/kg (P-MVcontr); (2) UP-MV with VT ≈3 ml/kg (UP-MVcontr); (3) UP-MV with VT ≈3 ml/kg and SB (UP-MVspont); and (4) UP-MV with VT ≈3 ml/kg and pressure supported SB (UP-MVPS). In UP-MV groups, extracorporeal carbon dioxide removal was used. The authors found that: (1) UP-MVcontr reduced diffuse alveolar damage score in dorsal lung zones (median[interquartile]) (12.0 [7.0 to 16.8] vs. 22.5 [13.8 to 40.8]), but worsened oxygenation and intrapulmonary shunt, compared to P-MVcontr; (2) UP-MVspont and UP-MVPS improved oxygenation and intrapulmonary shunt, and redistributed ventilation towards dorsal areas, as compared to UP-MVcontr; (3) compared to P-MVcontr, UP-MVcontr and UP-MVspont, UP-MVPS yielded higher levels of tumor necrosis factor-α (6.9 [6.5 to 10.1] vs. 2.8 [2.2 to 3.0], 3.6 [3.0 to 4.7] and 4.0 [2.8 to 4.4] pg/mg, respectively) and interleukin-8 (216.8 [113.5 to 343.5] vs. 59.8 [45.3 to 66.7], 37.6 [18.8 to 52.0], and 59.5 [36.1 to 79.7] pg/mg, respectively) in dorsal lung zones. In this model of severe acute respiratory distress syndrome, MV with VT ≈3 ml/kg and extracorporeal carbon dioxide removal without SB slightly reduced lung histologic damage, but not inflammation, as compared to MV with VT = 4 to 6 ml/kg. During UP-MV, pressure supported SB increased lung inflammation.

  11. Central respiratory and circulatory effects of Gymnodinium breve toxin in anaesthetized cats

    Science.gov (United States)

    Borison, Herbert L.; Ellis, Sydney; McCarthy, Lawrence E.

    1980-01-01

    1 In cats anaesthetized with pentobarbitone, observations were made on respiration, spontaneous and evoked diaphragmatic electromyograms, blood pressure, heart rate, indirectly-induced contractions of the anterior tibialis muscle and nictitating membrane, and electrical excitability of the inspiratory centre in the medulla oblongata. 2 Gymnodinium breve toxin (GBTX) was administered intravenously, intra-arterially to the brain, and intracerebroventricularly. Physiological effects were recorded while alveolar PCO2 was controlled at a constant level except when changes in gas tension were made in order to measure CO2-ventilatory responsiveness. 3 Adequate doses of GBTX given intravenously by bolus injection elicited a non-tachyphylactic reflex response triad of apnoea, hypotension and bradycardia mediated by the vagus nerves independently of arterial baroreceptor and chemoreceptor innervation. 4 After vagotomy, additional amounts of GBTX (i.v.) resulted in apneustic breathing, hypertension and tachycardia. The cardiovascular effects were abolished by ganglionic blockade with hexamethonium. 5 Smaller doses of GBTX were required intra-arterially and intracerebroventricularly than by the intravenous route of injection to produce respiratory irregularity and cardiovascular hyperactivity. 6 Evoked motor responses, electrical excitability of the medulla oblongata and CO2-ventilatory responsiveness were largely spared even though GBTX caused marked disturbances in respiratory rhythmicity and cardiovascular functions. 7 It is concluded that GBTX acts reflexly on vagally innervated receptors to evoke a Bezold-Jarisch effect but that the toxin further acts centrally to cause irregular breathholding and hypertension with tachycardia, leading ultimately to respiratory and circulatory failure. PMID:7191740

  12. Inhalation anaesthetics and climate change

    DEFF Research Database (Denmark)

    Andersen, Mads Peter Sulbæk; Sander, S P; Nielsen, O J

    2010-01-01

    Although the increasing abundance of CO(2) in our atmosphere is the main driver of the observed climate change, it is the cumulative effect of all forcing agents that dictate the direction and magnitude of the change, and many smaller contributors are also at play. Isoflurane, desflurane......, and sevoflurane are widely used inhalation anaesthetics. Emissions of these compounds contribute to radiative forcing of climate change. To quantitatively assess the impact of the anaesthetics on the forcing of climate, detailed information on their properties of heat (infrared, IR) absorption and atmospheric...

  13. The 'simple' general dental anaesthetic

    African Journals Online (AJOL)

    The patient who receives dental treatment under general anaesthesia is usually a child, one with special needs, or one who requires an extensive dental procedure. The term 'simple' general dental anaesthetic is therefore a misnomer. The concept of procedural sedation for dentistry is beyond the scope of this article. It.

  14. Tuberous sclerosis Anaesthetic considerations | Bosenberg ...

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 9, No 2 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Tuberous sclerosis Anaesthetic ...

  15. Breathing difficulty

    Science.gov (United States)

    Shortness of breath; Breathlessness; Difficulty breathing; Dyspnea ... There is no standard definition for difficulty breathing. Some people ... even though they don't have a medical condition. Others may ...

  16. Spontaneous pneumothorax in weightlifters.

    Science.gov (United States)

    Marnejon, T; Sarac, S; Cropp, A J

    1995-06-01

    Spontaneous pneumothorax is infrequently caused by strenuous exertion. To our knowledge there has only been one case of spontaneous pneumothorax associated with weightlifting reported in the medical literature. We describe three consecutive cases of spontaneous pneumothorax associated with weightlifting. We postulate that spontaneous pneumothorax in these patients may be secondary to improper breathing techniques. It is important that physicians and weight trainers be aware of the association between weight lifting and spontaneous pneumothorax and assure that proper instruction is given to athletes who work with weights.

  17. Weaning by gradual pressure support (PS reduction without an initial spontaneous breathing trial (SBT versus PS-supported SBT: A pilot study

    Directory of Open Access Journals (Sweden)

    K. Gnanapandithan

    2011-11-01

    Full Text Available Background and aim: Studies on weaning strategies have yielded conflicting results regarding the superiority of different methods. The aim of this RCT was to compare the efficacy of gradual pressure support (PS reduction without an initial spontaneous breathing trial (SBT with PS-supported SBT. Methods: Patients mechanically ventilated for >24 h were randomized to weaning by gradual reduction of PS without an initial SBT versus once daily SBT (PS 7 cm H2O. The primary outcomes were the rates of successful weaning trial and time to successful extubation. The secondary outcomes were the ICU and hospital length of stay, hospital mortality and the occurrence of ventilator-associated pneumonia (VAP. Results: Of the 120 patients (61 males, median age 35 years, 58 were assigned to PS and 62 to the SBT group. The median (IQR duration of ventilation prior to weaning was 80.2 (50.5–175.6 h. The baseline characteristics were similar in the two groups except the PaO2/FiO2 ratio, which was significantly higher in SBT group. The rates of successful weaning trial (89.7% versus 69.4% were significantly higher in the PS group. The median duration of weaning (66 h versus 81.5 h, P = 0.05 and the median duration of ICU stay (8 days versus 9.4 days, P = 0.027 were lower in the PS group. There was no difference in hospital stay, mortality rates or occurrence of VAP in the two arms. On multivariate analysis, the duration of ventilation prior to weaning, baseline SOFA score and the weaning method were predictors of successful extubation. Conclusions: Gradual reduction of PS without an initial SBT was found to be associated with better outcomes compared to once daily PS-supported SBT. Resumo: Antecedentes e objetivo: Os estudos sobre estratégias de desmame tiveram resultados controversos em relação à superioridade de métodos diferentes. O objetivo deste RCT foi comparar a eficácia da redução gradual da press

  18. Cellular targets of inhalational anaesthetic- and opioid receptor ...

    African Journals Online (AJOL)

    Several anaesthetics and anaesthetic adjuvants have been shown to limit the extent of myocardial injury due to ischaemia and reperfusion, a protective phenomenon known as anaesthetic-induced cardioprotection. Inhalational anaesthetics and opioid receptor agonists are among the key players in anaesthetic-induced ...

  19. Breathing Problems

    Science.gov (United States)

    ... getting enough air. Sometimes you can have mild breathing problems because of a stuffy nose or intense ... panic attacks Allergies If you often have trouble breathing, it is important to find out the cause.

  20. An audit of anaesthetic record keeping

    African Journals Online (AJOL)

    QuickSilver

    One of the duties of any medical practitioner is to keep records ... It is concluded that the standard of record-keeping in this random sample falls far .... trend. It is, of course, possible that some of these practitio- ners regard the anaesthetic record as their personal document, and made their own anaesthetic records which they ...

  1. Anaesthetic considerations for paediatric laparoscopy | Lasersohn ...

    African Journals Online (AJOL)

    Children, infants and neonates represent an anaesthetic challenge because of age-specific anatomical and physiological issues. Apart from paediatric-specific anaesthetic considerations, the paediatric anaesthetist must understand the implications of laparoscopic surgery, and prevent and react appropriately to changes ...

  2. Efficacy of the ejector flow-meter. A scavenging device for anaesthetic gases

    Energy Technology Data Exchange (ETDEWEB)

    Obel, D.; Jorgensen, S.; Ferguson, A.; Frandsen, K.

    1985-01-01

    Measurements of air concentrations of nitrous oxide and halothane in the breathing zone of the anaesthetist and the operating-room nurse were carried out during inhalation anaesthesia with a Mapleson D system. Gas removal was performed from inside the breathing system at the same rate as that of the fresh gas inflow by means of an ejector flow-meter. The concentrations of nitrous oxide and halothane were maintained below the Danish Threshold Limit Values of 100 and 5 parts per million, respectively, by using this type of scavenging. When these anaesthetics were used simultaneously, the reduced Threshold Limit Values were not exceeded during endotracheal anaesthesia.

  3. Rural anaesthetic audit 2006 to 2010.

    Science.gov (United States)

    Mills, P D; Newbury, J

    2012-03-01

    In order to review anaesthetic morbidity in our remote rural hospital, a retrospective audit of all anaesthetic records was undertaken for a five-year period between 2006 and 2010. Eight hundred and eighty-nine anaesthetic records were reviewed. The patients were all American Society of Anaesthesiologists physical status I to III. Ninety-eight percent of the anaesthetics were performed by general practitioner (non-specialist) anaesthetists. There were no anaesthetic deaths or serious adverse outcomes reported over this period. Sixteen intraoperative and seven postoperative problems were documented, but all were resolved uneventfully. The most common problems documented were difficult intubation (n=9) and respiratory depression (n=3). Within the limitations of this retrospective audit, these findings indicate that general practitioner anaesthetists provided safe anaesthesia in a remote rural hospital. It is our opinion that the case selection, prior experience of anaesthetic and theatre staff, stable nursing workforce and the use of protocols were important factors in determining the low rate of adverse events. However, we caution against over-interpretation of the data, given its retrospective nature, relatively small sample size, reliance on case records and the absence of agreed definitions for adverse events. We would also like to encourage all anaesthetic services, however remote, to audit their results as part of ongoing quality assurance.

  4. Anaesthetic management of intussusception in pregnancy | Nwasor ...

    African Journals Online (AJOL)

    Teamwork will win and effective communication between obstetrician, surgeon, anesthesiologist and neonatologist is obligatory. Good knowledge of the simplest and fastest anaesthetic techniques available will ensure a fruitful outcome. Keywords: anaesthesia, intussusception, obstetric patients. Annals of African Medicine ...

  5. Mucopolysaccharidoses -An Adventurous Anaesthetic Encounter

    Directory of Open Access Journals (Sweden)

    Madhuri S Kurdi

    2008-01-01

    Full Text Available Cases of Mucopolysaccharidoses (MPS, though rare, may pose many challenges for the anaesthesiologist. Maintaining the airway may be extremely difficult even in the most experienced hands. We present here, two breath taking airway securing experiences-one emergency and the other elective- in a 10 year old child of Mucopolysaccharidoses (MPS who presented to us for repair of an irreducible umbilical hernia.

  6. Analysis of cricoid pressure application: anaesthetic trainee doctors vs. nursing anaesthetic assistants.

    Science.gov (United States)

    Yahaya, Nurul Haizam; Teo, Rufinah; Izaham, Azarinah; Tang, Shereen; Mohamad Yusof, Aliza; Abdul Manap, Norsidah

    2016-01-01

    To evaluate the ability of anaesthetic trainee doctors compared to nursing anaesthetic assistants in identifying the cricoid cartilage, applying the appropriate cricoid pressure and producing an adequate laryngeal inlet view. Eighty-five participants, 42 anaesthetic trainee doctors and 43 nursing anaesthetic assistants, were asked to complete a set of questionnaires which included the correct amount of force to be applied to the cricoid cartilage. They were then asked to identify the cricoid cartilage and apply the cricoid pressure on an upper airway manikin placed on a weighing scale, and the pressure was recorded. Subsequently they applied cricoid pressure on actual anaesthetized patients following rapid sequence induction. Details regarding the cricoid pressure application and the Cormack-Lehane classification of the laryngeal view were recorded. The anaesthetic trainee doctors were significantly better than the nursing anaesthetic assistants in identifying the cricoid cartilage (95.2% vs. 55.8%, p=0.001). However, both groups were equally poor in the knowledge about the amount of cricoid pressure force required (11.9% vs. 9.3% respectively) and in the correct application of cricoid pressure (16.7% vs. 20.9% respectively). The three-finger technique was performed by 85.7% of the anaesthetic trainee doctors and 65.1% of the nursing anaesthetic assistants (p=0.03). There were no significant differences in the Cormack-Lehane view between both groups. The anaesthetic trainee doctors were better than the nursing anaesthetic assistants in cricoid cartilage identification but both groups were equally poor in their knowledge and application of cricoid pressure. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  7. Analysis of cricoid pressure application: anaesthetic trainee doctors vs. nursing anaesthetic assistants

    Directory of Open Access Journals (Sweden)

    Nurul Haizam Yahaya

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVE: To evaluate the ability of anaesthetic trainee doctors compared to nursing anaesthetic assistants in identifying the cricoid cartilage, applying the appropriate cricoid pressure and producing an adequate laryngeal inlet view. METHODS: Eighty-five participants, 42 anaesthetic trainee doctors and 43 nursing anaesthetic assistants, were asked to complete a set of questionnaires which included the correct amount of force to be applied to the cricoid cartilage. They were then asked to identify the cricoid cartilage and apply the cricoid pressure on an upper airway manikin placed on a weighing scale, and the pressure was recorded. Subsequently they applied cricoid pressure on actual anaesthetized patients following rapid sequence induction. Details regarding the cricoid pressure application and the Cormack-Lehane classification of the laryngeal view were recorded. RESULTS: The anaesthetic trainee doctors were significantly better than the nursing anaesthetic assistants in identifying the cricoid cartilage (95.2% vs. 55.8%, p = 0.001. However, both groups were equally poor in the knowledge about the amount of cricoid pressure force required (11.9% vs. 9.3% respectively and in the correct application of cricoid pressure (16.7% vs. 20.9% respectively. The three-finger technique was performed by 85.7% of the anaesthetic trainee doctors and 65.1% of the nursing anaesthetic assistants (p = 0.03. There were no significant differences in the Cormack-Lehane view between both groups. CONCLUSION: The anaesthetic trainee doctors were better than the nursing anaesthetic assistants in cricoid cartilage identification but both groups were equally poor in their knowledge and application of cricoid pressure.

  8. Anaesthetic Management of A Child with Multiple Congenital Anomalies Scheduled for Cataract Extraction

    Directory of Open Access Journals (Sweden)

    Kalpana Kulkarni

    2009-01-01

    Full Text Available In infants& children variety of conditions and syndromes are associated with difficult Airway. Anaesthetic management becomes a challenge if it remains unrecognized until induction and sometimes results in disaster, leading to oropharyngeal trauma, laryngeal oedema, cardiovascular& neurological complications. A 4-month-old child with multiple congenital anomalies was posted for cataract extraction for early and better development of vision. He had history of post birth respiratory distress, difficulty in feeding, breath holding with delayed mile stones. He was treated as for Juvenile asthma. This child was induced with inhalation anaesthesia. There was difficulty in laryngoscopic intubation and could pass much smaller size of the tube than predicted. He developed post operative stridor and desaturation. The problems which we faced during the anaesthetic management and during postoperative period are discussed with this case.

  9. Breathing Difficulties

    Science.gov (United States)

    ... symptoms. Symptoms associated with weak respiratory muscles: Air “hunger” (gasping, labored breathing) with an without activity Fatigue ... Start your own fundraising event & help create a world without ALS Start an Event Site Map | Press ...

  10. Breath sounds

    Science.gov (United States)

    ... described as moist, dry, fine, and coarse. Rhonchi. Sounds that resemble snoring. They occur when air is blocked or air flow becomes rough through the large airways. Stridor. Wheeze-like sound heard when a person breathes. Usually it is ...

  11. Pre-anaesthetic screening of geriatric dogs

    Directory of Open Access Journals (Sweden)

    K.E. Joubert

    2007-05-01

    Full Text Available Pre-anaesthetic screening has been advocated as a valuable tool for improving anaesthetic safety and determining anaesthetic risk. This study was done determine whether pre-anaesthetic screening result in cancellation of anaesthesia and the diagnosis of new clinical conditions in geriatric dogs. One hundred and one dogs older than 7 years of age provided informed owner consent were included in the study. Each dog was weighed, and its temperature, pulse and respiration recorded. An abdominal palpation, examination of the mouth, including capillary refill time and mucous membranes, auscultation, body condition and habitus was performed and assessed. A cephalic catheter was placed and blood drawn for pre-anaesthetic testing. A micro-haematocrit tube was filled and the packed cell volume determined. The blood placed was in a test tube, centrifuged and then analysed on an in-house blood analyser. Alkaline phosphatase, alanine transferase, urea, creatinine, glucose and total protein were determined. A urine sample was then obtained by cystocentesis, catheterisation or free-flow for analysis. The urine specific gravity was determined with a refractometer. A small quantity of urine was then placed on a dip stick. Any new diagnoses made during the pre-anaesthetic screening were recorded. The average age of the dogs was 10.99+2.44 years and the weight was 19.64+15.78 kg. There were 13 dogs with pre-existing medical conditions. A total of 30 new diagnoses were made on the basis of the pre-anaesthetic screening. The most common conditions were neoplasia, chronic kidney disease and Cushing's disease. Of the 30 patients with a new diagnosis, 13 did not undergo anaesthesia as result of the new diagnosis. From this study it can be concluded that screening of geriatric patients is important and that sub-clinical disease could be present in nearly 30 % of these patients. The value of screening before anaesthesia is perhaps more questionable in terms of

  12. Extended release formulations for local anaesthetic agents.

    Science.gov (United States)

    Weiniger, C F; Golovanevski, L; Domb, A J; Ickowicz, D

    2012-08-01

    Systemic toxicity through overdose of local anaesthetic agents is a real concern. By encapsulating local anaesthetics in biodegradable carriers to produce a system for prolonged release, their duration of action can be extended. This encapsulation should also improve the safety profile of the local anaesthetic as it is released at a slower rate. Work with naturally occurring local anaestheticss has also shown promise in the area of reducing systemic and neurotoxicity. Extended duration local anaesthetic formulations in current development or clinical use include liposomes, hydrophobic based polymer particles such as Poly(lactic-co-glycolic acid) microspheres, pasty injectable and solid polymers like Poly(sebacic-co-ricinoleic acid) P(SA:RA) and their combination with synthetic and natural local anaesthetic. Their duration of action, rationale and limitations are reviewed. Direct comparison of the different agents is limited by their chemical properties, the drug doses encapsulated and the details of in vivo models described. Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

  13. Anaesthetic Management of Conjoined Twins′ Separation Surgery

    Directory of Open Access Journals (Sweden)

    Kolli S Chalam

    2009-01-01

    Full Text Available Anaesthesia for conjoined twins, either for separation surgery, or for MRI or other evaluation procedures is an enormous challenge to the paediatric anaesthesiologist. This is an extra challenging surgery because we the anaesthesiologists need to care for two patients at the same time instead of just one. Anaesthesia for conjoined twins ′separation surgery mainly centered on the following concerns: 1.Conjoined Twins′ physiology like crossed circulation. distribution of blood volume and organ sharing with their anaesthetic implications. 2.Long marathon surgery with massive fluid shifts and loss of blood & blood components and their rapid replenishment. 3.Meticulous planning for organized management of long hours of anaesthetic administration in two paediatric subjects simultaneously with multi surgical specialties involvement and their unique requirements.We report the anaesthetic and intensive care management of one pair of Pygopagus separation surgery and also the review of literature and world statistics.

  14. Anaesthetic, procedure and complications management of serial whole-lung lavage in an obese patient with pulmonary alveolar proteinosis: case report.

    Science.gov (United States)

    Rebelo, Helena Marta; Guedes, Luisa; Veiga, Dalila; Fiuza, Antonio C; Abelha, Fernando

    2012-01-01

    The first case of Pulmonary Alveolar Proteinosis (PAP) was described by Rose in 1958, but it is still a rare disorder. PAP is characterized by deposition of lipoproteinaceous material secondary to abnormal processing of surfactant by macrophages. Patients may suffer from progressive dyspnea and cough that at times is accompanied by worsening hypoxia and its course can vary from progressive deterioration to spontaneous improvement. Many therapies have been used to treat PAP including antibiotics, postural drainage, and intermittent positive pressure breathing with aerosolized Acetylcysteine, heparin and saline. At present, the mainstay of treatment is whole lung lavage (WLL). Although generally well tolerated, WLL can be associated with some complications. We report a case of severe PAP through the anaesthetic, procedure and complications management of pulmonary alveolar proteinosis in one patient who has undergone multiple, alternating, single-lung lavages over the past seven years, the last three in our hospital, with improvements in her symptoms following each therapy. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

  15. Local anaesthetics and chondrotoxicty: What is the evidence?

    LENUS (Irish Health Repository)

    Baker, Joseph F

    2012-11-01

    Recent reports have suggested that local anaesthetic agents have a toxic effect on articular chondrocytes. This is despite the widespread intra-articular use of local anaesthetic agents following arthroscopic procedures for a number of years.

  16. Flow requirements in the Hafnia modifications of the Mapleson circuits during spontaneous respiration.

    Science.gov (United States)

    Christensen, K N; Thomsen, A; Hansen, O; Jørgensen, S

    1978-01-01

    The Mapleson A, B, C and D circuits can be changed into non-polluting circuits by employing continuous gas evacuation directly from the circuit, via an ejector flowmeter (Jørgensen 1974); Mapleson A and C circuits with this modification have been described previously as the Hafnia A and C circuits (Christensen 1976, Thomsen & Jørgensen 1976). If evacuation from a closed reservoir is employed, total removal of the expired and surplus gases from the operating theatre is obtained (Jørgensen & Thomsen 1976). There will be resistance to expiration in all the circuits with a relief valve for the discharge of surplus gas. If surplus gas is continuously removed directly from the anaesthetic circuit, the patient breathes in an air compartment at ambient pressure, as long as the removal rate equals the inflow of fresh gas. The relief valve is only included in the circuit to ensure that high pressures do not develop. As in any other circuit, the relief valve remains open except during controlled ventilation. A dumping valve may also be included as a safeguard against low pressures (Jørgensen & Thomsen 1976). The flow requirements of the Hafnia B and D circuits and the corresponding Mapleson circuits have been studied in conscious, spontaneously breathing subjects, and the results are discussed in relation to the flow requirements of other semi-closed system.

  17. Periodic Classification of Local Anaesthetics (Procaine Analogues

    Directory of Open Access Journals (Sweden)

    Gloria Castellano

    2006-01-01

    Full Text Available Algorithms for classification are proposed based on criteria (information entropyand its production. The feasibility of replacing a given anaesthetic by similar ones in thecomposition of a complex drug is studied. Some local anaesthetics currently in use areclassified using characteristic chemical properties of different portions of their molecules.Many classification algorithms are based on information entropy. When applying theseprocedures to sets of moderate size, an excessive number of results appear compatible withdata, and this number suffers a combinatorial explosion. However, after the equipartitionconjecture, one has a selection criterion between different variants resulting fromclassification between hierarchical trees. According to this conjecture, for a given charge orduty, the best configuration of a flowsheet is the one in which the entropy production is mostuniformly distributed. Information entropy and principal component analyses agree. Theperiodic law of anaesthetics has not the rank of the laws of physics: (1 the properties ofanaesthetics are not repeated; (2 the order relationships are repeated with exceptions. Theproposed statement is: The relationships that any anaesthetic p has with its neighbour p 1are approximately repeated for each period.

  18. Anaesthetic Challenges Associated with Achondroplasia: A Case ...

    African Journals Online (AJOL)

    We report the anaesthetic management of two achondroplastic patients who presented for emergency cesarean section. Regional anaesthesia could not be done in both cases as a result of technical difficulties and general anaesthesia was performed. Airway management was done with two different techniques following ...

  19. Local anaesthetics: Characteris tics, uses and toxicities

    African Journals Online (AJOL)

    pharmacological properties and are used in various techniques of local anaesthesia administration, i.e. ... As always, good judgement is necessary – an insulin- dependent, diabetic vasculopathic patient with ... He entered private practice in Bloemfontein and has risen to senior partner in a large private anaesthetic practice.

  20. Anaesthetic management of endoscopic resection of juvenile ...

    African Journals Online (AJOL)

    Two patients had preoperative embolisation of the feeding vessel. Standard anaesthesia induction technique, together with invasive monitoring, was used. Controlled hypotension (mean arterial pressure of 60 ± 5 mmHg) was achieved with the help of inhalational anaesthetics, vasodilators and beta blockers. Mean duration ...

  1. Anaesthetic gases: environmental impact and alternatives

    African Journals Online (AJOL)

    Review Article: Anaesthetic gases: environmental impact and alternatives. 345. 2011;17(5). South Afr J Anaesth Analg. Introduction. In recent times there has been a surge in interest in our contribution to climate change. Human activity results in increased atmospheric levels of a variety of gaseous chemicals that are able to ...

  2. Anaesthetic management for ventriculoperitoneal shunt insertion in ...

    African Journals Online (AJOL)

    Dandy–Walker Syndrome (DWS) is a rare congenital brain anomaly affecting the cerebellum and the fourth ventricle. The chief ... describes the successful anaesthetic management of an infant with Dandy–Walker Syndrome without postoperative intensive .... Involvement of respiratory centres in the brainstem may result in.

  3. Anaesthetic genetics and genomics | Welch | Southern African ...

    African Journals Online (AJOL)

    Some common genetically determined anaesthetic conditions, such as malignant hyperthermia, “scoline apnoea”, “halothane hepatitis” and porphyria, are fairly well described, and the genetic differences in enzyme, receptor and ion channel systems are slowly being elucidated. These genomic differences allow some ...

  4. Anaesthetic potency and physiological effects of refrigerated ...

    African Journals Online (AJOL)

    Several in vitro studies have justified the use of thiopentone solutions beyond the period recommended by the manufacturer. We conducted this in vivo study to investigate the anaesthetic potency and physiological effect of refrigerated thiopentone solution. Rabbits in four groups designated A, B, C and D were ...

  5. Bad Breath

    Science.gov (United States)

    ... fresh and healthy. Tips for preventing bad breath: Brush your teeth (and tongue!) for at least two minutes twice ... and drinks. This helps prevent damage to your teeth and is great for your overall health. Brush after sweets. If you eat or drink sugary ...

  6. Achondroplasia: anaesthetic challenges for caesarean section.

    Science.gov (United States)

    Dubiel, L; Scott, G A; Agaram, R; McGrady, E; Duncan, A; Litchfield, K N

    2014-08-01

    Pregnancy in women with achondroplasia presents major challenges for anaesthetists and obstetricians. We report the case of a woman with achondroplasia who underwent general anaesthesia for an elective caesarean section. She was 99cm in height and her condition was further complicated by severe kyphoscoliosis and previous back surgery. She was reviewed in the first trimester at the anaesthetic high-risk clinic. A multidisciplinary team was convened to plan her peripartum care. Because of increasing dyspnoea caesarean section was performed at 32weeks of gestation. She received a general anaesthetic using a modified rapid-sequence technique with remifentanil and rocuronium. The intraoperative period was complicated by desaturation and high airway pressures. The woman's postoperative care was complicated by respiratory compromise requiring high dependency care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Congenital lobar emphysema in neonates: Anaesthetic challenges

    Directory of Open Access Journals (Sweden)

    Mridu Paban Nath

    2011-01-01

    Full Text Available Congenital lobar emphysema (CLE is a potentially reversible, though possibly life-threatening, cause of respiratory distress in the neonate. It poses dilemma in diagnosis and management. We are presenting a 6-week-old baby who presented with a sudden onset of respiratory distress related to CLE affecting the left upper lobe. Lobectomy was performed under general anaesthesia with one lung ventilation. The details of anaesthetic challenges and management are described here.

  8. Variability of exhaled breath condensate (EBC) volume and pH using a feedback regulated breathing pattern

    Science.gov (United States)

    Exhaled breath condensate (EBC) is a valuable biological medium for non-invasively measuring biomarkers with the potential to reflect organ systems responses to environmental and dietary exposures and disease processes. Collection of EBC has typically been with spontaneous breat...

  9. Inspired humidity in anaesthesia breathing circuits: comparison and examination of effect of Revell circulator.

    Science.gov (United States)

    Flynn, P J; Morris, L E; Askill, S

    1984-11-01

    Humidity levels of respired gases in spontaneously breathing patients were measured with a quadrupole mass spectrometer (Medishield Model MS-2) and compared between various anaesthetic systems during clinical anaesthesia. In studies of high flow rebreathing non-absorption systems the mean inspired absolute humidity averaged approximately 16 mg X l-1 (range 14.7 to 16.1 mg X l-1) compared to a semiclosed circle absorption system (BOC MK III) in which values for absolute humidity varied from 6.8 +/- 5.1 mg X l-1 for children through 9.5 +/- 3.0 mg X l-1 for adults), and the closed circle absorption system in which values of 20.5 +/- 2.3 mg X l-1 were only gradually reached. Addition of a functioning Revell circulator to the circle absorption system provided immediately markedly higher levels of inspired humidity during clinical use, either semiclosed (15.4 +/- 5.1 mg X l-1 in children to 18.8 +/- 2.4 mg X l-1 in adults), or closed (23.3 +/- 1.8 mg X l-1 in adults). These markedly higher inspired levels of absolute humidity were attained during forced circulation of respired gas provided by the Revell circulator without the concomitant disadvantages of rebreathing or the potential hazards associated with some humidifying devices.

  10. Breath holding spell

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000967.htm Breath holding spell To use the sharing features on this page, please enable JavaScript. Some children have breath holding spells. This is an involuntary stop in breathing ...

  11. Deep breathing after surgery

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000440.htm Deep breathing after surgery To use the sharing features on ... way to do so is by doing deep breathing exercises. Deep breathing keeps your lungs well-inflated ...

  12. Breathing difficulty - lying down

    Science.gov (United States)

    ... short of breath; Paroxysmal nocturnal dyspnea; PND; Difficulty breathing while lying down; Orthopnea; Heart failure - orthopnea ... Heart failure Obesity (does not directly cause difficulty breathing while lying down but often worsens other conditions ...

  13. Apolo Ohno: Breathing Easier

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Breathing Easier Apolo Ohno: Breathing Easier Past Issues / Fall 2013 Table of Contents ... training, I started experiencing decreased exercise endurance, trouble breathing, and coughing. These symptoms affected my ability to ...

  14. Rapid shallow breathing

    Science.gov (United States)

    Tachypnea; Breathing - rapid and shallow; Fast shallow breathing; Respiratory rate - rapid and shallow ... Shallow, rapid breathing has many possible medical causes, including: Asthma Blood clot in an artery in the lung Choking Chronic obstructive ...

  15. Breathing and Relaxation

    Science.gov (United States)

    ... Home Health Insights Stress & Relaxation Breathing and Relaxation Breathing and Relaxation Make an Appointment Ask a Question ... level is often dependent on his or her breathing pattern. Therefore, people with chronic lung conditions may ...

  16. Breathing difficulties - first aid

    Science.gov (United States)

    Difficulty breathing - first aid; Dyspnea - first aid; Shortness of breath - first aid ... Breathing difficulty is almost always a medical emergency. An exception is feeling slightly winded from normal activity, ...

  17. Traveling with breathing problems

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000066.htm Traveling with breathing problems To use the sharing features on this page, please enable JavaScript. If you have breathing problems and you: Are short of breath most ...

  18. Breathing - slowed or stopped

    Science.gov (United States)

    ... bradypnea. Labored or difficult breathing is known as dyspnea. ... Premature birth Seizures Common causes of breathing trouble (dyspnea) in adults include: Allergic reaction that causes tongue, ...

  19. Peri-anaesthetic complications in an equine referral hospital: Risk factors for post anaesthetic colic.

    Science.gov (United States)

    Jago, R C; Corletto, F; Wright, I M

    2015-11-01

    Peri-anaesthetic complications are relatively common in equine patients and further investigations are warranted to identify manageable risk factors. To report morbidity and mortality rates and identify associated risk factors for horses undergoing general anaesthesia, within a predominantly racing Thoroughbred (TB) population. Single centre retrospective observational study. Anaesthetic and case records of all horses ≥12 months old undergoing general anaesthesia at Newmarket Equine Hospital between August 2010 and April 2012 were analysed, excluding emergency abdominal/dystocia procedures or traumatology cases with cardiovascular compromise. Mortality and morbidity rates were calculated and described. Uni- and multivariable analyses were used to investigate the relationship between the principal complication, post anaesthetic colic (PAC) and risk factors. A total of 1067 anaesthetic records of 1021 horses were included in the study; of these, 702 horses (65.8%) were TB, 169 (15.8%) developed a complication within 7 days of general anaesthesia and 10 (0.94%) died as a result. The most prevalent morbidity was PAC, 111 horses (10.5%) developed colic within 7 days of general anaesthesia. Thoroughbred horses (odds ratio [OR] 2.93, 95% confidence interval [CI] 1.73-4.96) and horses receiving sodium benzylpenicillin (NaBP) (OR 2.77, 95% CI 1.69-4.50) were at increased risk of PAC. Thoroughbred racehorses were identified as at increased risk of PAC in this study and might benefit from more critical evaluation of post anaesthetic gastrointestinal function. An alternative to the administration of NaBP for prophylactic antimicrobial therapy needs to be further investigated if its role in PAC is confirmed by other studies. © 2015 EVJ Ltd.

  20. Fast-starting for a breath: Air breathing in Hoplosternum littorale

    DEFF Research Database (Denmark)

    Domenici, Paolo; Norin, Tommy; Bushnell, Peter G.

    by the fall of a prey item on the water surface, and in tapping motions of goldfish, a behaviour that was interpreted to be food-related. Little is known about C-starts being used outside the context of escaping or feeding. Here, we test the hypothesis that air-breathing fish may use C-starts when gulping air...... at the surface. Air breathing is a common behaviour in many fish species when exposed to hypoxia, although certain species perform air-breathing in normoxia to fill their swim bladders for buoyancy control and/or sound transduction. Hoplosternum littorale is an air-breathing freshwater catfish found in South...... America. Field video observations reveal that their air-breathing behaviour consists of a fast air-gulping motion at the surface, followed by swimming towards the bottom. Using high-speed video in the laboratory, we compared the kinematics of spontaneous air-gulping performed by H. littorale in normoxia...

  1. The anaesthetic potency of benzocaine-hydrochloride in three ...

    African Journals Online (AJOL)

    Marking (1967) and Houston & Woods (1976) also showed that the anaesthetic potency of a drug depends on the temperature of the water at which anaesthesia is in- duced. The results of this study confmn these fmdings because the induction of anaesthesia at different water temperatures resulted in different anaesthetic ...

  2. The long-term consequences of anaesthetic management | Sessler ...

    African Journals Online (AJOL)

    Thus, it is reasonable to ask to what extent anaesthetic management might influence long-term outcomes. The distinction being made here is between the classical definition of anaesthetic complications, which is restricted to the immediate perioperative period, perhaps extending to a few days after surgery, and the ...

  3. Accidental deposition of local anaesthetic in the subdural space ...

    African Journals Online (AJOL)

    2013-01-16

    Jan 16, 2013 ... local anaesthetic occurs rarely and few anaesthesiologists are familiar with its clinical presentation.2-4 We report on a case of suspected subdural deposition of local anaesthetic in an infant who was administered caudal anaesthesia for postoperative pain relief. The case report and a review of literature are ...

  4. Anaesthetic indices and vital parameters of PPR-infected West ...

    African Journals Online (AJOL)

    The aim of this study, was to assess and compare the anaesthetic indices and vital parameters of West African Dwarf (WAD) goats naturally infected with PPR before and after epidural anaesthesia with plain lignocaine and also to compare the measured anaesthetic indices with those of healthy goats. Ten goats were used ...

  5. What is anaesthetic death? | Tudjegbe | Annals of Biomedical ...

    African Journals Online (AJOL)

    Anaesthetic death” is often defined as the death of a patient who has had an anaesthetic, within 24 hours of the procedure. This is irrespective of the contribution of anaesthesia to the cause of death. Many people disagree with this definition. We illustrate this point by presenting the case of a 5-year old boy who had ...

  6. Accidental deposition of local anaesthetic in the subdural space ...

    African Journals Online (AJOL)

    The incidence of accidental injection of local anaesthetic into the subdural space during neuraxial blockade is rare. The presentation of unexplainable clinical signs that do not match the clinical picture of subarachnoid or intravascular injection of the local anaesthetic agent should invoke high suspicion of unintentional ...

  7. Anaesthetic management of appendectomy in a patient with ...

    African Journals Online (AJOL)

    Background: The aim of anaesthetic management for appendectomy in a patient with cerebral arteriovenous malformation (AVM) is to maintain a stable cardiovascular system. As this condition is rare, there are no definitive guidelines regarding the anaesthetic management of such patients. Case report: We report a case of ...

  8. Anaesthetic manpower development in West Africa.

    Science.gov (United States)

    Soyannwo, O A; Elegbe, E O

    1999-01-01

    Advances in surgery have been possible worldwide largely due to specialized manpower, innovations in modern anaesthetic techniques and drugs. Shortage of specialist manpower in anaesthesia has continued in West Africa despite various available local postgraduate training programmes. This paper examines the impact of the West African Postgraduate Medical College (WAPMC) training programme on anaesthetic manpower development in the West Africa subregion. Data collected from the records of the WAPMC revealed that from April 1992 to October 1996 a total number of 2,963 candidates attempted the primary examination of the various surgical faculties compared to 93 candidates for anaesthesia--a ratio of 32 prospective surgeons to one anaesthetist. The end point of the training produced 292 Fellows in the five-year period with only six in anaesthesia, i.e., 1 anaesthetist to 49 surgeons. Although the diploma programme of the same College produced 56 graduates in the study period, 53.6% of them were pursuing the Fellowship programme in tertiary institutions. Suggestions are proposed to redress the ever-widening gap between the number of specialist surgeons and anaesthetists in the West Africa subregion.

  9. Influence of pre-anaesthetic thoracic radiographs on ASA physical status classification and anaesthetic protocols in traumatized dogs and cats

    International Nuclear Information System (INIS)

    Sigrist, N.; Mosing, M.; Iff, I.; Larenza, M.P.; Lang, J.; Spreng, D.

    2008-01-01

    The purpose of this study was to evaluate if pre-anaesthetic thoracic radiographs contribute to the anaesthetic management of trauma patients by comparing American Society of Anesthesiologists Physical Status Classification (ASA grade) with and without information from thoracic radiography findings. Case records of 157 dogs and cats being anaesthetized with or without post-traumatic, pre-anaesthetic chest radiographs were retrospectively evaluated for clinical parameters, radiographic abnormalities and anaesthetic protocol. Animals were retrospectively assigned an ASA grade. ASA grades, clinical signs of respiratory abnormalities and anaesthesia protocols were compared between animals with and without chest radiographs. The group of animals without pre-anaesthetic radiographs was anaesthetized earlier after trauma and showed less respiratory abnormalities at presentation. The retrospectively evaluated ASA grade significantly increased with the information from thoracic radiography. Animals with a higher ASA grade were less frequently mechanically ventilated. Pre-anaesthetic radiographs may provide important information to assess the ASA grade in traumatized patients and may therefore influence the anesthesia protocol

  10. Slow Breathing and Hypoxic Challenge: Cardiorespiratory Consequences and Their Central Neural Substrates

    OpenAIRE

    Critchley, Hugo D.; Nicotra, Alessia; Chiesa, Patrizia A.; Nagai, Yoko; Gray, Marcus A.; Minati, Ludovico; Bernardi, Luciano

    2015-01-01

    Controlled slow breathing (at 6/min, a rate frequently adopted during yoga practice) can benefit cardiovascular function, including responses to hypoxia. We tested the neural substrates of cardiorespiratory control in humans during volitional controlled breathing and hypoxic challenge using functional magnetic resonance imaging (fMRI). Twenty healthy volunteers were scanned during paced (slow and normal rate) breathing and during spontaneous breathing of normoxic and hypoxic (13% inspired O2)...

  11. Non-Anaesthetic Effects of Volatile Anaesthetics: A Short Trip on the Sea of Translational Medicine.

    Science.gov (United States)

    Krzych, Lukasz J; Szczepanska, Anna J

    2017-10-13

    Volatile anaesthetics (VA) are commonly used worldwide for induction and/or maintenance of general anaesthesia. They act in the central nervous system to reduce sensation and motor response during surgical and invasive diagnostic procedures. VAs also have some non-anaesthetic properties in the brain when administrated to patients at the extremes of age. Their biological impact on other organs should be taken into account during administration of anaesthesia. In this review we summarize the recent knowledge on the non-anaesthetic effects of inhaled halogenic ethers on cells and tissues. Exposure to VAs may promote lasting neuro-behavioural deficits in the brains of developing children and deterioration in cognitive performance in elderly individuals. Preconditioning with VAs can prevent or minimise tissue ischaemia in the heart and brain. VAs act as an anti-inflammatory in response to tissue damage during surgery and may attenuate both local and systemic inflammatory response. Further research is needed to elucidate a link between laboratory findings and their possible effects in humans. Because many questions remain unanswered in this field, translational medicine should be more focused on safety in anaesthesia for the improvement public health. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  12. Spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Davari R

    1996-07-01

    Full Text Available A case with bilateral spontaneous pneumothorax was presented. Etiology, mechanism, and treatment were discussed on the review of literature. Spontaneous Pneumothorax is a clinical entity resulting from a sudden non traumatic rupture of the lung. Biach reported in 1880 that 78% of 916 patients with spontaneous pneumothorax had tuberculosis. Kjergaard emphasized 1932 the primary importance of subpleural bleb disease. Currently the clinical spectrum of spontaneous pneumothorax seems to have entered a third era with the recognition of the interstitial lung disease and AIDS as a significant etiology. Standard treatment is including: observation, thoracocentesis, tube thoracostomy. Chemical pleurodesis, bullectomy or wedge resection of lung with pleural abrasion and occasionally pleurectomy. Little information has been reported regarding the efficacy of such treatment in spontaneous pneumothorax secondary to non bleb disease

  13. The concept of anaesthetic-induced cardioprotection: clinical relevance

    NARCIS (Netherlands)

    de Hert, Stefan G.

    2005-01-01

    Experimental evidence has clearly demonstrated that volatile anaesthetic agents have direct protective properties against reversible and irreversible ischaemic myocardial damage. These properties have been related to a direct preconditioning effect but also to an effect on the extent of reperfusion

  14. Description of surgical and anaesthetic services provided at two ...

    African Journals Online (AJOL)

    Description of surgical and anaesthetic services provided at two district hospitals in KwaZulu-Natal in relation to the surgical norms and standards outlined in the Service Package for District Hospitals.

  15. Variation of tumour radiosensitivity with time after anaesthetic

    Energy Technology Data Exchange (ETDEWEB)

    Nias, A.H.W.; Perry, P.M. (Saint Thomas' Hospital, London (UK). Richard Dimbleby Research Lab.)

    1989-10-01

    Transplanted C{sub 3}H mouse mammary tumours were given single doses of X irradiation in air or oxygen at 1 atmosphere (atm) with or without anaesthesia of recipient mice by ketamine and diazepam. The radiation response to single doses of 25 Gy was determined in terms of time taken to reach 3.5 times the treatment volume. Under all conditions there was more growth delay in tumours irradiated in pure oxygen than in air. In air and oxygen, the radiation response for anaestheitized animals tended to fall below the level for non-anaesthetized ones when only 10 min had elapsed after administration of anaesthesia. After 25 min, the response in air was back to the level for non-anaesthetized animals but the oxygen group then showed significant sensitization compared with the oxygen without anaesthetic group. After 40 min, the air group showed slight sensitization and the oxygen group still showed significant sensitization by the anaesthetic. (author).

  16. The effects of some prostaglandins on respiration in anaesthetized cats

    Science.gov (United States)

    McQueen, D.S.

    1974-01-01

    1 Some prostaglandins have been found to be capable of affecting respiration in anaesthetized cats. 2 Prostaglandins E1, E2, F2α, A1 and A2 all elicited increases in respiratory frequency when administered to cats anaesthetized with either pentobarbitone or α-chloralose. This effect was abolished by bilateral vagotomy. 3 Prostaglandins of the E and A series, but not prostaglandin F2α, elicited increases in tidal volume which were accompanied by falls in systemic blood pressure in cats anaesthetized with pentobarbitone. The changes in blood pressure were also obtained in cats anaesthetized with α-chloralose, but not the tidal volume changes. 4 It is unlikely that the prostaglandins influenced respiration by direct actions on arterial chemoreceptors or baroreceptors. 5 Mechanisms by which the prostaglandins may be acting to affect respiration are discussed. PMID:4447858

  17. What Causes Bad Breath?

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español What Causes Bad Breath? KidsHealth / For Teens / What Causes Bad Breath? Print en español ¿Qué es lo ... through your mouth. Smoking is also a major cause of bad breath. There are lots of myths ...

  18. Breath-Holding Spells

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Breath-Holding Spells KidsHealth / For Parents / Breath-Holding Spells What's in ... Spells Print en español Espasmos de sollozo About Breath-Holding Spells Many of us have heard stories about stubborn ...

  19. Anaesthetic management of two Bengal tiger (Panthera tigris tigris cubs for fracture repair

    Directory of Open Access Journals (Sweden)

    Gareth E. Zeiler

    2013-02-01

    Full Text Available This case series describes the anaesthetic management of two sibling Bengal tiger (Panthera tigris tigris cubs that were found to have spontaneous femur fractures due to severe nutritional secondary hyperparathyroidism. Both cubs received a combination of medetomidine (25 µg/kg and ketamine (4 mg/kg intramuscularly and were maintained with isoflurane in oxygen. An epidural injection of morphine (0.1 mg/kg and ropivacaine (1.6 mg/kg was administered to both tigers, which allowed a low end-tidal isoflurane concentration to be maintained throughout the femur fracture reduction operations. Both cubs experienced profound bradycardia and hypotension during general anaesthesia, and were unresponsive to anticholinergic treatment. Possible causes for these cardiovascular complications included: drug pharmacodynamics (medetomidine, morphine, isoflurane, decreased sympathetic tone due to the epidural (ropivacaine and hypothermia. These possible causes are discussed in detail.

  20. Anaesthetic management of two Bengal tiger (Panthera tigris tigris cubs for fracture repair

    Directory of Open Access Journals (Sweden)

    Gareth E. Zeiler

    2013-11-01

    Full Text Available This case series describes the anaesthetic management of two sibling Bengal tiger (Panthera tigris tigris cubs that were found to have spontaneous femur fractures due to severe nutritional secondary hyperparathyroidism. Both cubs received a combination of medetomidine (25 µg/kg and ketamine (4 mg/kg intramuscularly and were maintained with isoflurane in oxygen. An epidural injection of morphine (0.1 mg/kg and ropivacaine (1.6 mg/kg was administered to both tigers, which allowed a low end-tidal isoflurane concentration to be maintained throughout the femur fracture reduction operations. Both cubs experienced profound bradycardia and hypotension during general anaesthesia, and were unresponsive to anticholinergic treatment. Possible causes for these cardiovascular complications included: drug pharmacodynamics (medetomidine, morphine, isoflurane, decreased sympathetic tone due to the epidural (ropivacaine and hypothermia. These possible causes are discussed in detail.

  1. The additional work of breathing imposed by Mapleson A systems.

    Science.gov (United States)

    Ooi, R; Pattison, J; Soni, N

    1993-07-01

    The additional work attributable to breathing through five Mapleson A anaesthetic breathing systems (Magill, Lack, Parallel Lack, Humphrey ADE and Enclosed Magill) was studied using a lung model. With all five systems, the additional work was found to be a function of fresh gas flow, respiratory flow as well as system geometry. Within the range of fresh gas flow and respiratory flow studied, the additional work ranged between 80 mJ.l-1 and 182 mJ.l-1. Expiratory work was always greater than the inspiratory workload. Increasing fresh gas inflow into the system increases expiratory work, both resistive and elastic components. The Magill system posed the least work expenditure. The values for the additional work obtained with the lung model were of the same order of magnitude when measurements were taken in volunteers.

  2. Spontaneous deregulation

    NARCIS (Netherlands)

    Edelman, Benjamin; Geradin, Damien

    Platform businesses such as Airbnb and Uber have risen to success partly by sidestepping laws and regulations that encumber their traditional competitors. Such rule flouting is what the authors call “spontaneous private deregulation,” and it’s happening in a growing number of industries. The authors

  3. The effect of a heat and moisture exchanger on gas flow in a Mapleson F breathing system during inhalational induction.

    Science.gov (United States)

    Da Fonseca, J M; Wheeler, D W; Pook, J A

    2000-06-01

    Heat and moisture exchangers (HMEs) humidify, warm and filter inspired gas, protecting patients and apparatus during anaesthesia. Their incorporation into paediatric anaesthetic breathing systems is recommended. We experienced delays in inhalational induction whilst using a Mapleson F breathing system with an HME. We have demonstrated that the HME significantly alters gas flow within the breathing system. Approximately half of the fresh gas flow is delivered to the patient, the remainder being wasted into the expiratory limb of the breathing system. We suggest that the HME should be removed from the Mapleson F breathing system until inhalational induction is complete, or that the reservoir bag is completely occluded until an effective seal is obtained with the mask.

  4. Exhaled Carbon Dioxide and Neonatal Breathing Patterns in Preterm Infants after Birth.

    Science.gov (United States)

    Nicoll, Jessica; Cheung, Po-Yin; Aziz, Khalid; Rajani, Vishaal; O'Reilly, Megan; Pichler, Gerhard; Schmölzer, Georg M

    2015-10-01

    To examine the amount of exhaled carbon dioxide (ECO2) with different breathing patterns in spontaneously breathing preterm infants after birth. Preterm infants had a facemask attached to a combined carbon dioxide/flow sensor placed over their mouth and nose to record ECO2 and gas flow. A breath-by-breath analysis of the first 5 minutes of the recording was performed. Thirty spontaneously breathing preterm infants, gestational age (mean ± SD) 30 ± 2 weeks and birth weight 1635 ± 499 g were studied. ECO2 from normal breaths and slow expirations was significantly larger than with other breathing patterns (P breath also increased with gestational age P breathing pattern both during the first minute of recording and overall. Breathing pattern proportions also varied by gestational age. Finally, ECO2 from the fifth minute of recording was significantly greater than that produced during the first 4 minutes of recording (P ≤ .029). ECO2 varies with different breathing patterns and increases with gestational age and over time. ECO2 may be an indicator of lung aeration and that postnatal ECO2 monitoring may be useful in preterm infants in the delivery room. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Local anaesthetic medication for the treatment of asthma

    Directory of Open Access Journals (Sweden)

    Rodrigo A Siqueira

    2005-03-01

    Full Text Available It is presumed that drugs able to prevent bronchial spasm and/or inflammation may have therapeutic potential to control asthma symptoms. The local anaesthetic lidocaine has recently received increased attention as an alternative form of treatment for asthmatic patients. This paper reviews the major findings on the topic and summarizes the putative mechanisms underlying the airway effects of local anaesthetic agents. We think that lidocaine extends the spectrum of options in asthma therapy, probably by counteracting both spasmogenic and inflammatory stimuli in the bronchial airways. The possibility of development of new anti-asthma compounds based on the synthesis of lidocaine derivatives is also on the horizon.

  6. Imposed work of breathing during high-frequency oscillatory ventilation : a bench study

    NARCIS (Netherlands)

    van Heerde, Marc; van Genderingen, Huib R.; Leenhoven, Tom; Roubik, Karel; Ploetz, Frans B.; Markhorst, Dick G.

    2006-01-01

    Introduction The ventilator and the endotracheal tube impose additional workload in mechanically ventilated patients breathing spontaneously. The total work of breathing (WOB) includes elastic and resistive work. In a bench test we assessed the imposed WOB using 3100 A/3100 B SensorMedics

  7. How to breathe when you are short of breath

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000053.htm How to breathe when you are short of breath ... Watch TV Use your computer Read a newspaper How to do Pursed lip Breathing The steps to ...

  8. Breathing patterns and cardiovascular autonomic modulation during hypoxia induced by simulated altitude.

    Science.gov (United States)

    Bernardi, L; Passino, C; Wilmerding, V; Dallam, G M; Parker, D L; Robergs, R A; Appenzeller, O

    2001-05-01

    To assess the influence of different breathing patterns on autonomic cardiovascular modulation during acute exposure to altitude-induced hypoxia. We measured relative changes in minute ventilation (VE), oxygen saturation (%SaO2), spectral analysis of RR interval and blood pressure, and response to stimulation of carotid baroreceptors (neck suction) at baseline and after acute (1 h) hypobaric hypoxia (equivalent to 5,000 m, in a hypobaric chamber). We studied 19 human subjects: nine controls and 10 Western yoga trainees of similar age, while breathing spontaneously, at 15 breaths/min (controlled breathing) and during 'complete yogic breathing' (slow diaphragmatic + thoracic breathing, approximately 5 breaths/min) in yoga trainees, or simple slow breathing in controls. At baseline %SaO2, VE and autonomic pattern were similar in both groups; simulated altitude increased VE in controls but not in yoga trainees; %SaO2 decreased in all subjects (Pbreathing, controlled breathing and yogic or slow breathing, respectively). Simulated altitude decreased RR interval (from 879 +/- 45 to 770 +/- 39, P breathing. No effect of altitude was seen on stimulation of carotid baroreceptors in both groups. Well-performed slow yogic breathing maintains better blood oxygenation without increasing VE (i.e. seems to be a more efficient breathing) and reduces sympathetic activation during altitude-induced hypoxia.

  9. Eldercare at Home: Breathing Problems

    Science.gov (United States)

    ... Join our e-newsletter! Resources Eldercare at Home: Breathing Problems Caregiving How Tos Understanding the Problem As ... However, aging sometimes brings on other more serious breathing problems including incapacitating shortness of breath, chest discomfort, ...

  10. From breathing to respiration.

    Science.gov (United States)

    Fitting, Jean-William

    2015-01-01

    The purpose of breathing remained an enigma for a long time. The Hippocratic school described breathing patterns but did not associate breathing with the lungs. Empedocles and Plato postulated that breathing was linked to the passage of air through pores of the skin. This was refuted by Aristotle who believed that the role of breathing was to cool the heart. In Alexandria, breakthroughs were accomplished in the anatomy and physiology of the respiratory system. Later, Galen proposed an accurate description of the respiratory muscles and the mechanics of breathing. However, his heart-lung model was hampered by the traditional view of two non-communicating vascular systems - veins and arteries. After a period of stagnation in the Middle Ages, knowledge progressed with the discovery of pulmonary circulation. The comprehension of the purpose of breathing progressed by steps thanks to Boyle and Mayow among others, and culminated with the contribution of Priestley and the discovery of oxygen by Lavoisier. Only then was breathing recognized as fulfilling the purpose of respiration, or gas exchange. A century later, a controversy emerged concerning the active or passive transfer of oxygen from alveoli to the blood. August and Marie Krogh settled the dispute, showing that passive diffusion was sufficient to meet the oxygen needs. © 2014 S. Karger AG, Basel.

  11. Breath alcohol test (image)

    Science.gov (United States)

    The breath alcohol test measures the amount of alcohol in the blood by testing exhaled air. The test is performed by blowing ... breath machine 15 minutes after alcohol consumption. The test determines how much alcohol it takes to raise the blood-alcohol level ...

  12. Minimizing Shortness of Breath

    Science.gov (United States)

    ... is also placed on proper use of the abdominal muscles to better control episodes of shortness of breath, limit overuse of the accessory muscles and manage respiratory symptoms. Monitor Breathing During an activity, it is important to pause frequently to check ...

  13. Local anaesthetics: Characteris tics, uses and toxicities | Du Plessis ...

    African Journals Online (AJOL)

    Surgeons currently perform more and larger procedures in an ambulatory setting. Local anaesthesia is an important aspect of office-based surgery. Local anaesthetics (LAs) vary in their pharmacological properties and are used in various techniques of local anaesthesia administration, i.e. topical, infiltrative, epidural, spinal, ...

  14. Lavage drain extension for local anaesthetic instillation into ...

    African Journals Online (AJOL)

    Thirty-one patients who had undergone abdominoplasty procedures were selected for instillation of a local anaesthetic preparation, ropivacaine (Naropin, AstraZeneca) into the wound site on day 1 and 2 after surgery, followed by early mobilisation. Efficacy of the system, patient comfort and mobilisation were documented.

  15. Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

    Directory of Open Access Journals (Sweden)

    Liana Maria Torres de Araújo Azi

    2016-01-01

    Full Text Available We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.

  16. Radiation induced changes in the airway - anaesthetic implications ...

    African Journals Online (AJOL)

    Radiation induced changes in the airway - anaesthetic implications: case report. Mallika Balakrishnan, Renju Kuriakose, Rachel Cherian Koshy. Abstract. Radiation induces a variety of changes in the airway that can potentially lead to difficult intubation. Osteoradionecrosis (ORN) of the mandible, a severe consequence of ...

  17. Case Report: Anaesthetic management of a Rare Oesophageal ...

    African Journals Online (AJOL)

    Foreign body impaction is a common and potentially fatal condition encountered by both anaesthetists and surgeons. Skilled airway management is vital to avoid catastrophic outcomes. Children less than five years of age are particularly vulnerable. We report the anaesthetic challenges and management of a 2 year old boy ...

  18. Iatrogenic greenhouse gases: the role of anaesthetic agents.

    Science.gov (United States)

    Uzoigwe, Chika E; Sanchez Franco, Luis C; Forrest, Michael D

    2016-01-01

    The contribution of health-care activity to climate change is not negligible and is increasing. Anaesthetic greenhouse gases, in particular the fluranes, have a much more potent global warming capacity, volume for volume, than carbon dioxide, but their emissions remain completely unregulated.

  19. Cleft lip and palate surgery in children: Anaesthetic considerations ...

    African Journals Online (AJOL)

    Background: The Care of cleft patients is very challenging. Team cleft care is usually lacking in many developing countries due to shortage of qualified manpower. This study is aimed at highlighting anaesthetic challenges in the management of cleft in children. Patients and Methods: This was a study of cleft lip and palate ...

  20. Bronchoscopy for foreign body removal in children: anaesthetic ...

    African Journals Online (AJOL)

    Bronchoscopy for foreign body removal in children: anaesthetic challenges in a tertiary health Centre. ... Patients and Methods: This is a retrospective review of cases of foreign body aspiration in children treated at the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, between 2002 and 2008. Foreign body ...

  1. Anaesthetic management of a patient with sick sinus syndrome for ...

    African Journals Online (AJOL)

    Anaesthetic management of a patient with sick sinus syndrome for exploratory laparotomy. S Alex, JP Saneesh, R Rao, M Upadya. Abstract. Sick sinus syndrome is a generalised abnormality of cardiac impulse formation that may be caused either by an intrinsic disease of the sinus node, which makes it unable to perform its ...

  2. Anaesthetic Management of Homozygous Sickle Cell Patients at ...

    African Journals Online (AJOL)

    Background: Sickle cell disease is a common comorbidity in patient presenting for surgical care in our hospitals. The aim of this study was to evaluate the outcome of anaesthetic management of sickle cell disease patients in our hospital. Patients and method: A prospective audit was conducted for a period of 12 months, ...

  3. Comparative Analysis Of The Effects Of Topical Anaesthetic Agents ...

    African Journals Online (AJOL)

    Thus, of these three topical anaesthetic agents, 0.5% tetracaine hydrochloride may be the preferred choice in optometric practice particularly in patients with Keratoconjunctivitis Sicca (KCS) in order to facilitate their tear film stability;while the use of proparacaine should be discouraged in patients with dry eye syndrome.

  4. The influence of anaesthetic drug selection for scoliosis surgery on ...

    African Journals Online (AJOL)

    Abstract. Aim: The aim of this study was to conduct a pharmaceutical care programme for two different anaesthetic methods used during scoliosis surgery, to investigate which method ensured better intraoperative haemodynamic stability and postoperative pain control. Methods: A clinical pharmacist actively participated in a ...

  5. Paravertebral block as a sole technique for the anaesthetic ...

    African Journals Online (AJOL)

    Myalgic encephalomyelitis (ME) is a multifaceted organic disease which, owing to its non-specific multiple symptoms that include incapacitating fatigue, deeply affects the quality of life of diseased patients. It carries a perceived risk of an adverse reaction to drugs, including anaesthetics. However, there is very little ...

  6. Anaesthetic effects of xylazine/ketamine combination in New ...

    African Journals Online (AJOL)

    The anaesthetic effects of xylazine/ketamine drug combination was studied using New-Zealand white (NZW) rabbits. The animals were grouped into three as follows; Group A (Control) animals were pre-medicated with 5mg/kg xylazine (X) intramuscularly (i/m), followed 10 minutes later with 35mg/kg Ketamine(K) i/m .

  7. comparative analysis of the effects of topical anaesthetic agents on ...

    African Journals Online (AJOL)

    LIVINGSTON

    influx of sodium ions into the nerve cytoplasm. It binds to the specific ... 0.5% proparacaine hydrochloride had a statistically significant decrease in tear quantity produced after instillation, using the ... topical anaesthetic agents, 0.5% tetracaine hydrochloride may be the preferred choice in optometric practice particularly in ...

  8. Anaesthetic Challenges in the Surgical Management of Diabetic ...

    African Journals Online (AJOL)

    Anaesthetic Challenges in the Surgical Management of Diabetic Foot Disease at Enugu. ... Themortality in this study was seen only in males, and all related to delay in accepting the operation, the degree of sepsis and fasting blood sugar level. Conclusion: Diabetics for gangrenous lower limb amputation are high risk ...

  9. special position for the anaesthetic management of a patient with ...

    African Journals Online (AJOL)

    2010-03-01

    Mar 1, 2010 ... was too huge to allow adoption of the supine position for induction of anaesthesia. In order to achieve a suit- ... Keywords: Anaesthetic position, Operating table, Gi- ant mass, Airway management, General .... tions of stroke and death related to shoulder sur- gery in the sitting position. Arthroscopy 2008.

  10. Caesarean section wound infiltration with local anaesthetic for ...

    African Journals Online (AJOL)

    For outcome in terms of the visual analogue pain score (0 - 10) over 24 hours, no advantage was demonstrated in the single study of 50 participants who had wound infiltration with a mixture of local analgesia and narcotics versus local analgesia. Conclusions. Local anaesthetic infiltration and abdominal nerve blocks as ...

  11. The anaesthetic potency of benzocaine-hydrochloride in three ...

    African Journals Online (AJOL)

    The anaesthetic potency of benzocaine-hydrochloride in three freshwater fish species. J.T. Ferreira, H.J. Schoonbee and G.L. Smit. Research Unit for Fish Biology, Rand Afrikaans University, Johannesburg. Anaesthesia was induced in the common carp, Cyprinus carpio, tilapia, Oreochromis mossambicus and rainbow trout, ...

  12. The role of Src & ERK1/2 kinases in inspiratory resistive breathing induced acute lung injury and inflammation.

    Science.gov (United States)

    Toumpanakis, Dimitrios; Vassilakopoulou, Vyronia; Sigala, Ioanna; Zacharatos, Panagiotis; Vraila, Ioanna; Karavana, Vassiliki; Theocharis, Stamatios; Vassilakopoulos, Theodoros

    2017-12-13

    Inspiratory resistive breathing (IRB), a hallmark of obstructive airway diseases, is associated with large negative intrathoracic pressures, due to strenuous contractions of the inspiratory muscles. IRB is shown to induce lung injury in previously healthy animals. Src is a multifunctional kinase that is activated in the lung by mechanical stress. ERK1/2 kinase is a downstream target of Src. We hypothesized that Src is activated in the lung during IRB, mediates ERK1/2 activation and IRB-induced lung injury. Anaesthetized, tracheostomized adult rats breathed spontaneously through a 2-way non-rebreathing valve. Resistance was added to the inspiratory port to provide a peak tidal inspiratory pressure of 50% of maximum (inspiratory resistive breathing). Activation of Src and ERK1/2 in the lung was estimated during IRB. Following 6 h of IRB, respiratory system mechanics were measured by the forced oscillation technique and bronchoalveolar lavage (BAL) was performed to measure total and differential cell count and total protein levels. IL-1b and MIP-2a protein levels were measured in lung tissue samples. Wet lung weight to total body weight was measured and Evans blue dye extravasation was estimated to measure lung permeability. Lung injury was evaluated by histology. The Src inhibitor, PP-2 or the inhibitor of ERK1/2 activation, PD98059 was administrated 30 min prior to IRB. Src kinase was activated 30 min after the initiation of IRB. Src inhibition ameliorated the increase in BAL cellularity after 6 h IRB, but not the increase of IL-1β and MIP-2a in the lung. The increase in BAL total protein and lung injury score were not affected. The increase in tissue elasticity was partly inhibited. Src inhibition blocked ERK1/2 activation at 3 but not at 6 h of IRB. ERK1/2 inhibition ameliorated the increase in BAL cellularity after 6 h of IRB, blocked the increase of IL-1β and returned Evans blue extravasation and wet lung weight to control values. BAL total protein and

  13. Submarines, spacecraft and exhaled breath.

    Science.gov (United States)

    Pleil, Joachim D; Hansel, Armin

    2012-03-01

    extend the underwater endurance to 2-3 weeks. These propulsion engineering changes also reduce periodic ventilation of the submarine's interior and thus put a greater burden on the various maintenance systems. We note that the spaceflight community has similar issues; their energy production mechanisms are essentially air independent in that they rely almost entirely on photovoltaic arrays for electricity generation, with only emergency back-up power from alcohol fuel cells. In response to prolonged underwater submarine AIP operations, months-long spaceflight operations onboard the ISS and planning for future years-long missions to Mars, there has been an increasing awareness that bio-monitoring is an important factor for assessing the health and awareness states of the crewmembers. SAMAP researchers have been proposing various air and bio-monitoring instruments and methods in response to these needs. One of the most promising new methodologies is the non-invasive monitoring of exhaled breath. So, what do the IABR and SAMAP communities have in common? Inhalation toxicology. We are both concerned with contamination from the environment, either as a direct health threat or as a confounder for diagnostic assessments. For example, the exhaled breath from subjects in a contaminated and enclosed artificial environment (submarine or spacecraft) can serve as a model system and a source of contamination for their peers in a cleaner environment. In a similar way, exhaled anaesthetics can serve as a source of contamination in hospital/clinical settings, or exhalation of occupational exposures to tetrachloroethylene can impact family members at home. Instrumentation development. Both communities have similar needs for better, more specific and more sensitive instruments. Certainly, the analytical instruments to be used onboard submarines and spacecraft have severe restrictions on energy use, physical size and ease of operation. The medical and clinical communities have similar long

  14. Liberation From Mechanical Ventilation in Critically Ill Adults: An Official American College of Chest Physicians/American Thoracic Society Clinical Practice Guideline: Inspiratory Pressure Augmentation During Spontaneous Breathing Trials, Protocols Minimizing Sedation, and Noninvasive Ventilation Immediately After Extubation.

    Science.gov (United States)

    Ouellette, Daniel R; Patel, Sheena; Girard, Timothy D; Morris, Peter E; Schmidt, Gregory A; Truwit, Jonathon D; Alhazzani, Waleed; Burns, Suzanne M; Epstein, Scott K; Esteban, Andres; Fan, Eddy; Ferrer, Miguel; Fraser, Gilles L; Gong, Michelle Ng; Hough, Catherine L; Mehta, Sangeeta; Nanchal, Rahul; Pawlik, Amy J; Schweickert, William D; Sessler, Curtis N; Strøm, Thomas; Kress, John P

    2017-01-01

    An update of evidence-based guidelines concerning liberation from mechanical ventilation is needed as new evidence has become available. The American College of Chest Physicians (CHEST) and the American Thoracic Society (ATS) have collaborated to provide recommendations to clinicians concerning liberation from the ventilator. Comprehensive evidence syntheses, including meta-analyses, were performed to summarize all available evidence relevant to the guideline panel's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, and the results were summarized in evidence profiles. The evidence syntheses were discussed and recommendations developed and approved by a multidisciplinary committee of experts in mechanical ventilation. Recommendations for three population, intervention, comparator, outcome (PICO) questions concerning ventilator liberation are presented in this document. The guideline panel considered the balance of desirable (benefits) and undesirable (burdens, adverse effects, costs) consequences, quality of evidence, feasibility, and acceptability of various interventions with respect to the selected questions. Conditional (weak) recommendations were made to use inspiratory pressure augmentation in the initial spontaneous breathing trial (SBT) and to use protocols to minimize sedation for patients ventilated for more than 24 h. A strong recommendation was made to use preventive noninvasive ventilation (NIV) for high-risk patients ventilated for more than 24 h immediately after extubation to improve selected outcomes. The recommendations were limited by the quality of the available evidence. The guideline panel provided recommendations for inspiratory pressure augmentation during an initial SBT, protocols minimizing sedation, and preventative NIV, in relation to ventilator liberation. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights

  15. Breath hydrogen analysis in patients with ileoanal pouch anastomosis

    DEFF Research Database (Denmark)

    Bruun, E; Meyer, J N; Rumessen, J J

    1995-01-01

    The possible influence on functional outcomes of hydrogen production in the ileoanal pouch after restorative proctocolectomy was investigated by means of lactulose H2 breath tests. Eight of 15 patients had significant increases in breath hydrogen after 10 g lactulose. One patient declined...... to participate in further investigations, the remaining seven responders had no evidence of small bowel bacterial overgrowth after glucose H2 breath tests. The ability to produce hydrogen by anaerobic fermentation of lactulose in the pouch was unrelated to the age of the patients or of the pouch. Seven of eight...... responders had successive breath tests after ingestion of lactulose 20 g and wheat starch 100 g. Five of seven had significant increases after lactulose but none after wheat starch. The overall function of the pouch continence, spontaneity of defecation, and 24 hour stool frequency was significantly better...

  16. Shortness of Breath

    Science.gov (United States)

    ... enough air. Shortness of breath — known medically as dyspnea — is often described as an intense tightening in ... properly. Schwartzstein RM. Approach to the patient with dyspnea. http://www.uptodate.com/home. Accessed Feb. 4, ...

  17. Chronic fluorosis: The disease and its anaesthetic implications

    Directory of Open Access Journals (Sweden)

    Madhuri S Kurdi

    2016-01-01

    Full Text Available Chronic fluorosis is a widespread disease-related to the ingestion of high levels of fluoride through water and food. Prolonged ingestion of fluoride adversely affects the teeth, bones and other organs and alters their anatomy and physiology. Fluoride excess is a risk factor in cardiovascular disease and other major diseases, including hypothyroidism, diabetes and obesity. Although anaesthesiologists may be aware of its skeletal and dental manifestations, other systemic manifestations, some of which may impact anaesthetic management are relatively unknown. Keeping this in mind, the topic of chronic fluorosis was hand searched from textbooks, scientific journals and electronically through Google, PubMed and other scientific databases. This article concentrates on the effect of chronic fluorosis on various organ systems, its clinical features, diagnosis and the anaesthetic implications of the disease.

  18. Anaesthetic Efficacy of Sodium Bicarbonate and its Effects on the ...

    African Journals Online (AJOL)

    Anaesthetic efficacy of Sodium bicarbonate (NaHC03) and its effects on haematology of African Catfish (Clarias gariepinus) in five different concentrations [0.00 g/L (control), 50.00, 100.00, 150.00 and 200.00 g/L] were determined in two sizes: juvenile (mean length 26.64 cm ± 3.11SD; mean weight 356.21 g ± 12.91SD) ...

  19. Slow breathing as a means to improve orthostatic tolerance: a randomized sham-controlled trial.

    Science.gov (United States)

    Lucas, Samuel J E; Lewis, Nia C S; Sikken, Elisabeth L G; Thomas, Kate N; Ainslie, Philip N

    2013-07-15

    Endogenous oscillations in blood pressure (BP) and cerebral blood flow have been associated with improved orthostatic tolerance. Although slow breathing induces such responses, it has not been tested as a therapeutic strategy to improve orthostatic tolerance. With the use of a randomized, crossover sham-controlled design, we tested the hypothesis that breathing at six breaths/min (vs. spontaneous breathing) would improve orthostatic tolerance via inducing oscillations in mean arterial BP (MAP) and cerebral blood flow. Sixteen healthy participants (aged 25 ± 4 yr; mean ± SD) had continuous beat-to-beat measurements of middle cerebral artery blood velocity (MCAv), BP (finometer), heart rate (ECG), and end-tidal carbon dioxide partial pressure during an incremental orthostatic stress test to presyncope by combining head-up tilt with incremental lower-body negative pressure. Tolerance time to presyncope was improved (+15%) with slow breathing compared with spontaneous breathing (29.2 ± 5.4 vs. 33.7 ± 6.0 min; P breathing) across time from baseline to presyncope. Our findings show that orthostatic tolerance can be improved within healthy individuals with a simple, nonpharmacological breathing strategy. The mechanisms underlying this improvement are likely mediated via the generation of negative intrathoracic pressure during slow and deep breathing and the related beneficial impact on cerebrovascular and autonomic function.

  20. Inhibition of protein kinase C by alcohols and anaesthetics.

    Science.gov (United States)

    Slater, S J; Cox, K J; Lombardi, J V; Ho, C; Kelly, M B; Rubin, E; Stubbs, C D

    1993-07-01

    Despite almost a century of research, the mechanism of anaesthesia remains obscure and there is still no agreement on the location of the site(s) of action. Because the potencies of general anaesthetics increase in proportion to their solubility in olive oil, this led to a consensus that the site is within the cell membrane. This led to theories that lipid bilayer perturbation was the primary event, which was then transmitted to a membrane protein. But at the concentrations used clinically, such perturbations are small. A plausible site would be in or on ion channels at the synapse, where a number of modulatory effects have been described. A possible location for such a site would be at the protein-lipid interface. We report here that anaesthetics inhibit protein kinase C, a key component in signal transduction. The potency is a linear function of the octanol-water partition coefficient (the Meyer-Overton rule of anaesthesia). The effect was obtained in a lipid-free assay, implicating a hydrophobic site in the protein, supporting the contention that a (membrane) protein may be a target for anaesthetic interactions. In a lipid-dependent assay, a potential role of lipids in the protein-site model was demonstrated. The inhibition was absent in the isolated catalytic domain, suggesting that the site of inhibition is on the regulatory subunit, which is unique to protein kinase C.

  1. Evaluation of halothane as an anaesthetic in camels (Camelus dromedarius).

    Science.gov (United States)

    Singh, R; Peshin, P K; Patil, D B; Sharda, R; Singh, J; Singh, A P; Sharifi, D

    1994-06-01

    Halothane as an anaesthetic was evaluated in 12 adult camels, thiopentone being used as an induction agent. In six camels, clinical signs and haematological and blood biochemical changes were investigated while in other six haemodynamic, acid base and blood gas changes were monitored. The dose of thiopentone required to ensure intubation for halothane anaesthesia was 7.25 +/- 0.33 mg/kg. A modified technique of tracheal intubation was found to be safe and quick. During halothane administration all anaesthetic effects were predictable. Complete recovery occurred in 39.5 +/- 9.8 min after discontinuation of halothane administration. Halothane moderated the thiopentone-induced tachycardia. The mean arterial pressure decreased significantly. There was an increase in the arterial carbon dioxide and venous oxygen tension during halothane anaesthesia and development of hypoxaemia after its discontinuation. The alanine aminotransferase values increased during recovery, while plasma sodium, potassium and calcium decreased. Halothane appears to be safe for camels. However, to avoid hypoxaemia in the immediate post-anaesthetic period, oxygen administration should be continued.

  2. Anaesthetic Management of a Patient with Pseudo-TORCH Syndrome

    Directory of Open Access Journals (Sweden)

    Derya Berk

    2013-09-01

    Full Text Available Background: Pseudo-TORCH syndrome is a rare, chronic disorder that is characterised by dimorphic features such as microcephaly, intracranial calcification, seizures, mental retardation, hepatosplenomegaly and coagulation disorders. Case Report: We present the anaesthetic management of a forty day-old boy with Pseudo-TORCH syndrome during magnetic resonance imaging. Microcephaly, growth failure, high palate and bilateral rales in the lungs were detected in pre-anaesthetic physical examination. The peripheral oxygen saturation was 88-89% in room-air and was 95% in a hood with 5 L/min oxygen. We planned general anaesthesia to ensure immobility during magnetic resonance imaging. After standard monitoring, general anaesthesia was induced with 8% sevoflurane in 100% O2. After an adequate depth of anaesthesia was reached, we inserted a supraglottic airway device to avoid intubation without the use of a muscle relaxant. Conclusion: In patients with Pseudo-TORCH syndrome, the perioperative anaesthetic risk was increased. We believe that using a supraglottic airway device to secure the airway is less invasive than intubation, and can be performed without the need of muscle relaxants.

  3. Anaesthetic Management of a Patient with Pseudo-TORCH Syndrome.

    Science.gov (United States)

    Berk, Derya; Kuş, Alparslan; Sahin, Tülay; Solak, Mine; Toker, Kamil

    2013-09-01

    Pseudo-TORCH syndrome is a rare, chronic disorder that is characterised by dimorphic features such as microcephaly, intracranial calcification, seizures, mental retardation, hepatosplenomegaly and coagulation disorders. We present the anaesthetic management of a forty day-old boy with Pseudo-TORCH syndrome during magnetic resonance imaging. Microcephaly, growth failure, high palate and bilateral rales in the lungs were detected in pre-anaesthetic physical examination. The peripheral oxygen saturation was 88-89% in room-air and was 95% in a hood with 5 L/min oxygen. We planned general anaesthesia to ensure immobility during magnetic resonance imaging. After standard monitoring, general anaesthesia was induced with 8% sevoflurane in 100% O2. After an adequate depth of anaesthesia was reached, we inserted a supraglottic airway device to avoid intubation without the use of a muscle relaxant. In patients with Pseudo-TORCH syndrome, the perioperative anaesthetic risk was increased. We believe that using a supraglottic airway device to secure the airway is less invasive than intubation, and can be performed without the need of muscle relaxants.

  4. Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis?

    LENUS (Irish Health Repository)

    Heaney, A

    2012-12-01

    Summary Cancer is a leading cause of morbidity and mortality worldwide and the ratio of incidence is increasing. Mortality usually results from recurrence or metastases. Surgical removal of the primary tumour is the mainstay of treatment, but this is associated with inadvertent dispersal of neoplastic cells into the blood and lymphatic systems. The fate of the dispersed cells depends on the balance of perioperative factors promoting tumour survival and growth (including surgery per se, many anaesthetics per se, acute postoperative pain, and opioid analgesics) together with the perioperative immune status of the patient. Available evidence from experimental cell culture and live animal data on these factors are summarized, together with clinical evidence from retrospective studies. Taken together, current data are sufficient only to generate a hypothesis that an anaesthetic technique during primary cancer surgery could affect recurrence or metastases, but a causal link can only be proved by prospective, randomized, clinical trials. Many are ongoing, but definitive results might not emerge for a further 5 yr or longer. Meanwhile, there is no hard evidence to support altering anaesthetic technique in cancer patients, pending the outcome of the ongoing clinical trials.

  5. Model-based characterization of ventilatory stability using spontaneous breathing

    OpenAIRE

    Nemati, Shamim; Edwards, Bradley A.; Sands, Scott A.; Berger, Philip J.; Wellman, Andrew; Verghese, George C.; Malhotra, Atul; Butler, James P.

    2011-01-01

    Cyclic ventilatory instabilities are widely attributed to an increase in the sensitivity or loop gain of the chemoreflex feedback loop controlling ventilation. A major limitation in the conventional characterization of this feedback loop is the need for labor-intensive methodologies. To overcome this limitation, we developed a method based on trivariate autoregressive modeling using ventilation, end-tidal Pco2 and Po2; this method provides for estimation of the overall “loop gain” of the resp...

  6. Development of anaesthetic protocols for lumpfish (Cyclopterus lumpus L.: Effect of anaesthetic concentrations, sea water temperature and body weight.

    Directory of Open Access Journals (Sweden)

    Malene W Skår

    Full Text Available In recent years, use of lumpfish (Cyclopterus lumpus L. as cleaner-fish to remove sea-lice have been chosen by many salmon farmers in Europe and Canada as an alternative to medical treatment, which has led to large scale production of lumpfish. At present, there is limited knowledge of how lumpfish respond upon anaesthesia, which anaesthetics and concentrations that are efficient and conditions for euthanasia. We have therefore tested and developed protocols for bath immersion for three commonly used anaesthetics metacaine (Finquel, buffered tricaine methanesulfonate, MS-222 and Tricaine Pharmaq, benzocaine (Benzoak vet and isoeugenol (Aqui-S, determined concentration for normal and fast anaesthesia and evaluated safety margin for each condition. Also, a behavioral matrix has been developed. We have examined the effect of fish size (10-20 g, 200-400 g and 600-1300 g and sea water temperature (6°C and 12°C. We found that 200 mg L-1 metacaine is an efficient dose for deep narcosis independently for fish size and temperature due to good safety margins with regards to both exposure times and doses. However, for many tasks lighter anaesthesia is sufficient, and then 100 mg L-1 metacaine can be used. Benzocaine is less efficient than metacaine, but can be used as anaesthetic of fish 600 g, benzocaine is not suitable. Isoeugenol cannot be recommended for full anesthesia of lumpfish. The conditions for lethal doses varied with chosen anaesthetic, fish size and temperature. For small fish (10-20 g, exposure to 1600 mgL-1 of metacaine in 10 minutes it lethal. Guided protocols for non-lethal anaesthesia will contribute to ensure safe treatment of lumpfish according to an ethical standard for good fish welfare.

  7. Spontaneously emerging cortical representations of visual attributes

    Science.gov (United States)

    Kenet, Tal; Bibitchkov, Dmitri; Tsodyks, Misha; Grinvald, Amiram; Arieli, Amos

    2003-10-01

    Spontaneous cortical activity-ongoing activity in the absence of intentional sensory input-has been studied extensively, using methods ranging from EEG (electroencephalography), through voltage sensitive dye imaging, down to recordings from single neurons. Ongoing cortical activity has been shown to play a critical role in development, and must also be essential for processing sensory perception, because it modulates stimulus-evoked activity, and is correlated with behaviour. Yet its role in the processing of external information and its relationship to internal representations of sensory attributes remains unknown. Using voltage sensitive dye imaging, we previously established a close link between ongoing activity in the visual cortex of anaesthetized cats and the spontaneous firing of a single neuron. Here we report that such activity encompasses a set of dynamically switching cortical states, many of which correspond closely to orientation maps. When such an orientation state emerged spontaneously, it spanned several hypercolumns and was often followed by a state corresponding to a proximal orientation. We suggest that dynamically switching cortical states could represent the brain's internal context, and therefore reflect or influence memory, perception and behaviour.

  8. Mutagenicity of inhalation anaesthetics studied by the sister chromatid exchange test in lymphocytes of patients and operating room personnel.

    Science.gov (United States)

    Husum, B

    1987-06-01

    Retrospective studies have indicated that operating room personnel may have increased risks of spontaneous abortion, congenital malformations in offspring, and cancer (Cohen et al 1980, Buring et al 1985). Occupational exposure to waste anaesthetic gases may be responsible for these possible adverse health effects, but a cause-effect relationship has never been proved. Induction of changes in the DNA in the chromosomes leading to mutations may play a role in teratogenicity and carcinogenicity. Along with an increasing concern in society regarding occupational diseases and working and living environment in general, cytogenetic methods have been developed for rapid detection of potential mutagenicity in vitro of chemical agents. One such method is the SCE test, which is based on examination of sister chromatid exchanges (SCEs), i.e. exchanges of chromatid-segments between the two chromatids in a chromosome, during cell replication. SCEs are not mutations, but an increased frequency of SCE is a sensitive indicator of exposure to agents that are capable of producing damage to the DNA and thus possibly mutations. In vitro tests like the SCE test are very useful for evaluation of specific chemical agents, which may be added to the culture in known concentrations. In studies of possible hazards from chemical agents in the working or living environment, the exposure is often poorly defined. Also, biotransformation may be different in different species, and the duration and the level of the exposure may play a role. Examination of SCEs is, therefore, increasingly performed directly on human lymphocytes from peripheral blood. Thus, although the examination of SCEs is still performed in vitro, the exposure has taken place in vivo. Increased SCE levels are then regarded as a non-specific indicator that the donor has been exposed to potentially mutagenic agents in the environment. The author and his associates used the SCE test to investigate the possible mutagenicity of

  9. Consciously controlled breathing decreases the high-frequency component of heart rate variability by inhibiting cardiac parasympathetic nerve activity.

    Science.gov (United States)

    Sasaki, Konosuke; Maruyama, Ryoko

    2014-07-01

    Heart rate variability (HRV), the beat-to-beat alterations in heart rate, comprises sympathetic and parasympathetic nerve activities of the heart. HRV analysis is used to quantify cardiac autonomic regulation. Since respiration could be a confounding factor in HRV evaluation, some studies recommend consciously controlled breathing to standardize the method. However, it remains unclear whether controlled breathing affects HRV measurement. We compared the effects of controlled breathing on HRV with those of spontaneous breathing. In 20 healthy volunteers, we measured respiratory frequency (f), tidal volume, and blood pressure (BP) and recorded electrocardiograms during spontaneous breathing (14.8 ± 0.7 breaths/min) and controlled breathing at 15 (0.25 Hz) and 6 (0.10 Hz) breaths/min. Compared to spontaneous breathing, controlled breathing at 0.25 Hz showed a higher heart rate and a lower high-frequency (HF) component, an index of parasympathetic nerve activity, although the f was the same. During controlled breathing at 0.10 Hz, the ratio of the low frequency (LF) to HF components (LF/HF), an index of sympathetic nerve activity, increased greatly and HF decreased, while heart rate and BP remained almost unchanged. Thus, controlled breathing at 0.25 Hz, which requires mental concentration, might inhibit parasympathetic nerve activity. During controlled breathing at 0.10 Hz, LF/HF increases because some HF subcomponents are synchronized with f and probably move into the LF band. This increment leads to misinterpretation of the true autonomic nervous regulation. We recommend that the respiratory pattern of participants should be evaluated before spectral HRV analysis to correctly understand changes in autonomic nervous regulation.

  10. Respiratory hypoalgesia? Breath-holding, but not respiratory phase modulates nociceptive flexion reflex and pain intensity.

    Science.gov (United States)

    Jafari, Hassan; Van de Broek, Karlien; Plaghki, Léon; Vlaeyen, Johan W S; Van den Bergh, Omer; Van Diest, Ilse

    2016-03-01

    Several observations suggest that respiratory phase (inhalation vs. exhalation) and post-inspiratory breath-holds could modulate pain and the nociceptive reflex. This experiment aimed to investigate the role of both mechanisms. Thirty-two healthy participants received supra-threshold electrocutaneous stimulations to elicit both the Nociceptive Flexion Reflex (NFR) and pain, either during spontaneous inhalations or exhalations, or during three types of instructed breath-holds: following exhalation, at mid-inhalation and at full-capacity inhalation. Whether the electrocutaneous stimulus was applied during inhalation or exhalation did not affect the NFR or pain. Self-reported pain was reduced and the NFR was increased during breath-holding compared to spontaneous breathing. Whereas the type of breath-hold did not impact on self-reported pain, breath-holds at full-capacity inhalation and following exhalation were associated with a lower NFR amplitude compared to breath-holds at mid-inhalation. The present findings confirm that breath-holding can modulate pain (sensitivity) and suggest that both attentional distraction and changes in vagal activity may underlie the observed effects. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Breathing Like a Fish

    Science.gov (United States)

    Katsioloudis, Petros J.

    2010-01-01

    Being able to dive and breathe underwater has been a challenge for thousands of years. In 1980, Fuji Systems of Tokyo developed a series of prototype gills for divers as a way of demonstrating just how good its membranes are. Even though gill technology has not yet reached the point where recipients can efficiently use implants to dive underwater,…

  12. Breathing, feeding, and neuroprotection

    National Research Council Canada - National Science Library

    Homma, Ikuo; Shioda, S

    2006-01-01

    ... of knowledge of brain functions and morphology. Akiyoshi Hosoyamada, M.D., Ph.D. President Showa University, Tokyo 142-8555, Japan December 2005Preface Brain research is on the march, with several advanced technical developments and new findings uncovered almost daily. Within the brain-research fields, we focus on breathing, neuroprotection, an...

  13. The Breath of Chemistry

    DEFF Research Database (Denmark)

    Josephsen, Jens

    The present preliminary text is a short thematic presentation in biological inorganic chemistry meant to illustrate general and inorganic (especially coordination) chemistry in biochemistry. The emphasis is on molecular models to explain features of the complicated mechanisms essential to breathing...

  14. Patterns of anaesthetic pericranial nerve block in headache patients.

    Science.gov (United States)

    Santos Lasaosa, S; Gago Veiga, A; Guerrero Peral, Á L; Viguera Romero, J; Pozo-Rosich, P

    2018-04-01

    Anaesthetic blocks, whether used alone or combined with other treatments, are a therapeutic resource for many patients with headaches. However, usage patterns by different professionals show significant heterogeneity. The Headache Study Group of the Spanish Society of Neurology (GECSEN) designed a self-administered cross-sectional survey and sent it to all group members through the SEN's scientific area web platform in February 2016. The objective was to ascertain the main technical and formal aspects of this procedure and compare them with data obtained in a similar survey conducted in 2012. A total of 39 neurologists (mean age 41.74 years; SD: 9.73), 23 men (43.7 years; SD: 9.92) and 16 women (38.94 years; SD: 9.01) participated in this survey. Of these respondents, 76.9% used anaesthetic block in their clinical practice (79.16% in a tertiary-care hospital). The main indications were diagnosis and treatment of neuralgia (100%), prevention of chronic migraine (61.7%), episodic cluster headache (51.3%), and chronic cluster headache (66.7%). AB was used by 31% of the respondents to block only the lateral occipital complex, 13% also infiltrated the supraorbital nerve, and another 13% infiltrated the auriculotemporal nerve as well. The indications for anaesthetic blocks and the territories most frequently infiltrated are similar to those cited in the earlier survey. However, we observed increased participation in this latest survey and a higher percentage of young neurologists (35.89% aged 35 or younger), indicating that use of this technique has entered mainstream clinical practice. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Anaesthetic Impairment of Immune Function Is Mediated via GABAA Receptors

    Science.gov (United States)

    Wheeler, Daniel W.; Thompson, Andrew J.; Corletto, Federico; Reckless, Jill; Loke, Justin C. T.; Lapaque, Nicolas; Grant, Andrew J.; Mastroeni, Pietro; Grainger, David J.; Padgett, Claire L.; O'Brien, John A.; Miller, Nigel G. A.; Trowsdale, John

    2011-01-01

    Background GABAA receptors are members of the Cys-loop family of neurotransmitter receptors, proteins which are responsible for fast synaptic transmission, and are the site of action of wide range of drugs [1]. Recent work has shown that Cys-loop receptors are present on immune cells, but their physiological roles and the effects of drugs that modify their function in the innate immune system are currently unclear [2]. We are interested in how and why anaesthetics increase infections in intensive care patients; a serious problem as more than 50% of patients with severe sepsis will die [3]–[6]. As many anaesthetics act via GABAA receptors [7], the aim of this study was to determine if these receptors are present on immune cells, and could play a role in immunocompromising patients. Principal Findings We demonstrate, using RT-PCR, that monocytes express GABAA receptors constructed of α1, α4, β2, γ1 and/or δ subunits. Whole cell patch clamp electrophysiological studies show that GABA can activate these receptors, resulting in the opening of a chloride-selective channel; activation is inhibited by the GABAA receptor antagonists bicuculline and picrotoxin, but not enhanced by the positive modulator diazepam. The anaesthetic drugs propofol and thiopental, which can act via GABAA receptors, impaired monocyte function in classic immunological chemotaxis and phagocytosis assays, an effect reversed by bicuculline and picrotoxin. Significance Our results show that functional GABAA receptors are present on monocytes with properties similar to CNS GABAA receptors. The functional data provide a possible explanation as to why chronic propofol and thiopental administration can increase the risk of infection in critically ill patients: their action on GABAA receptors inhibits normal monocyte behaviour. The data also suggest a potential solution: monocyte GABAA receptors are insensitive to diazepam, thus the use of benzodiazepines as an alternative anesthetising agent may be

  16. Radon-in-breath measurement

    International Nuclear Information System (INIS)

    Leach, V.A.

    1981-01-01

    A review of literature on the area of radon breath measurements has shown that respiratory factors have been largely ignored. The history of breathing room-air radon concentrations and the variations in respiratory parameters for each individual have been the major contributing factors for poor reproducibility in radon breath measurements performed by past researchers

  17. Anaesthetic management of a child with massive extracranial arteriovenous malformation

    Directory of Open Access Journals (Sweden)

    Faisal Shamim

    2012-01-01

    Full Text Available Vascular tumors affect the head and neck commonly but arteriovenous malformations are rare. Vascular malformations are often present at birth and grow with the patient, usually only becoming significant later in childhood. Embolization has been the mainstay of treatment in massive and complex arteriovenous malformations. We present a case of massive extracranial arteriovenous malformation in a 7-year-old boy causing significant workload on right heart and respiratory distress. The management of angioembolization under general anaesthesia and anaesthetic concerns are presented.

  18. IgE-mediated reaction to local anaesthetics

    International Nuclear Information System (INIS)

    Kartal, O.; Gulec, M.; Sener, O.; Caliskaner, A.Z.

    2013-01-01

    Local anaesthetics (LAs) are essential agents in daily practices of dentistry, minor surgery and dermatology. Although they have an impressive history of safety and efficacy, LAs also have the potential to produce adverse events, which are mainly of non-immune nature. The true IgE-mediated allergies are quite rare, but are more considerable in terms of ability to cause life-threatening outcomes. In this report, we present a case of IgE-mediated systemic reaction to LAs occurring during epidural anaesthesia for Cesarean section. (author)

  19. Circle (CO2 reabsorbing) breathing systems: Human applications.

    Science.gov (United States)

    Magee, Patrick

    2017-07-01

    Artificial breathing systems to help humans survive extreme environments are used over a range of ambient pressures, using various gases of different volumetric concentrations. These activities include anaesthesia and intensive care activity, high-altitude mountaineering, firefighting, aerospace extravehicular space activity and underwater diving operations. A circle breathing system is one in which the exhaled carbon dioxide is absorbed by an alkali substance and the remaining unused gases are recirculated, usually for the sake of economy and environment. This allows the flow of the fresh gas to be considerably reduced, thereby saving on fresh-gas supply. Circle systems are often used in the circumstances cited above, although not always at low fresh-gas flows. The circle system used in anaesthesia and intensive care has the least engineering demands made on it, although it is used on patients who are highly vulnerable; it usually provides a mixture of air and oxygen, and perhaps a breathable anaesthetic gas, all at sea-level pressure. Mountaineering and firefighting applications involve an extreme earthbound environment, with the user undergoing extreme physical work. The astronaut's spacesuit and life support system contains a high-flow circle system, the breathing gases themselves pressurising the suit as well as providing respiratory life support and thermal comfort; the gas provided is pure oxygen at about a third of sea-level atmosphere. There are numerous varieties of breathing systems for diving, including a circle system, often for clandestine naval activity; the gases used are a combination of oxygen, nitrogen and helium, to minimise the possibility of decompression sickness, nitrogen narcosis and oxygen toxicity and must be provided at a varying pressure and concentration appropriate to depth.

  20. Distinct molecular sites of anaesthetic action: pentobarbital block of human brain sodium channels is alleviated by removal of fast inactivation

    NARCIS (Netherlands)

    Wartenberg, H. C.; Urban, B. W.; Duch, D. S.

    1999-01-01

    Fast inactivation of sodium channel function is modified by anaesthetics. Its quantitative contribution to the overall anaesthetic effect is assessed by removing the fast inactivation mechanism enzymatically. Sodium channels from human brain cortex were incorporated into planar lipid bilayers. After

  1. Strain-specific response to anaesthetics and analgesics in rat and rabbit : A pharmacogenetic approach

    NARCIS (Netherlands)

    Avsaroglu, H.

    2008-01-01

    The response of (laboratory) animals to anaesthetics and analgesics is known to show intraspecies variability. Apart from environmental influences, this may also be caused by genetic factors. In this thesis, rabbit and rat inbred strains were used to identify differences in response to anaesthetics

  2. Anaesthetic dilemma: spinal anaesthesia in an eclamptic patient with mild thrombocytopenia and an "impossible" airway.

    Science.gov (United States)

    Nafiu, O O; Salam, R A; Elegbe, E O

    2004-04-01

    We present our anaesthetic management of a 27-year-old woman with antepartum eclampsia, mild thrombocytopenia, difficult airway and clinical evidence of impending upper airway obstruction. She required urgent delivery by caesarean section, which was conducted uneventfully under spinal anaesthesia. We discuss the management conundrums presented by this case and why we chose spinal anaesthesia over other anaesthetic options.

  3. Fentanyl bolus induces muscle tremors in sevoflurane-anaesthetized piglets.

    Science.gov (United States)

    Ringer, S K; Spielmann, N; Weiss, M; Mauch, J Y

    2016-08-01

    Intravenous fentanyl (10 mcg/kg) or saline (control) was randomly administered to 10 healthy sevoflurane-mono-anaesthetized piglets. Trembling was assessed by two blinded observers using a visual analogue scale (VAS) and a simple ordinal scale at baseline and 5 min (T5) after drug administration. If no trembling was observed at that time point, the opposite treatment was administered and piglets were re-evaluated after another 5 min (T10). Four out of five piglets showed trembling after fentanyl (T5), while none given saline showed any trembling. With fentanyl the VAS scores were significantly higher at T5 compared either with baseline or with the control treatment. Control animals received fentanyl after the 5 min evaluation and all piglets showed clear trembling afterwards. The median time after fentanyl administration until first muscle tremors was 51 (20-840) s. In summary, nine out of 10 sevoflurane-anaesthetized piglets showed muscle tremors after intravenous fentanyl. Tremors subsided over time and no specific treatment was necessary. © The Author(s) 2015.

  4. Pressure and volume controlled mechanical ventilation in anaesthetized pregnant sheep.

    Science.gov (United States)

    Davis, J; Musk, G C

    2014-10-01

    Optimal mechanical ventilation of the pregnant ewe during anaesthesia is of vital importance for maintaining fetal viability. This study aimed to compare peak inspiratory pressure (PIP), oxygenation and cardiovascular parameters with pressure-control (PCV) or volume-control (VCV) mechanical ventilation of anaesthetized pregnant sheep. Twenty ewes at 110 days gestation underwent general anaesthesia in dorsal recumbency for fetal surgery in a research setting. All the sheep were mechanically ventilated; one group with PCV (n = 10) and another with VCV (n = 10) to maintain normocapnia. PIP, direct arterial blood pressure, heart rate, arterial pH and arterial oxygen tension were recorded. PIP was lower in the PCV group (P pressures were lower in the PCV group (P = 0.029 and P = 0.047, respectively). Both VCV and PCV provide adequate oxygenation of pregnant sheep anaesthetized in dorsal recumbency, though PCV may provide superior oxygenation at a lower PIP. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  5. The incidence of unpleasant dreams after sub-anaesthetic ketamine.

    Science.gov (United States)

    Blagrove, Mark; Morgan, Celia J A; Curran, H Valerie; Bromley, Leslie; Brandner, Brigitte

    2009-03-01

    Ketamine is an N-methyl-D: -aspartate (NMDA) receptor antagonist with psychotogenic effects and for which there are diverse reports of whether pleasant or unpleasant dreams result during anaesthesia, post-operatively or after sub-anaesthetic use. To assess in healthy volunteers the incidence of unpleasant dreams over the three nights after receiving a sub-anaesthetic dose of ketamine, in comparison to placebo, and with retrospective home nightmare frequency as a covariate. Thirty healthy volunteers completed questionnaires about retrospective home dream recall and were then given either ketamine (n = 19, males = 9, mean age = 23.5 years; mean ketamine blood plasma = 175.29 ng/mL) or placebo (n = 11, males = 5, mean age = 25.4 years). Dream recall and pleasantness/unpleasantness of dream content were recorded by questionnaire at home for the three nights after infusion. Ketamine resulted in significantly more mean dream unpleasantness relative to placebo and caused a threefold increase in the odds ratio for the incidence of an unpleasant dream. The number of dreams reported over the three nights did not differ between the groups. The incidence of unpleasant dreams after ketamine use was predicted by retrospectively assessed nightmare frequency at home. Ketamine causes unpleasant dreams over the three post-administration nights. This may be evidence of a residual psychotogenic effect that is not found on standard self-report symptomatology measures or a result of disturbed sleep electrophysiology.

  6. Burnout and the learning environment of anaesthetic trainees.

    Science.gov (United States)

    Castanelli, D J; Wickramaarachchi, S A; Wallis, S

    2017-11-01

    Burnout has a high prevalence among healthcare workers and is increasingly recognised as an environmental problem rather than reflecting a personal inability to cope with work stress. We distributed an electronic survey, which included the Maslach Burnout Inventory Health Services Survey and a previously validated learning environment instrument, to 281 Victorian anaesthetic trainees. The response rate was 50%. We found significantly raised rates of burnout in two of three subscales. Ninety-one respondents (67%) displayed evidence of burnout in at least one domain, with 67 (49%) reporting high emotional exhaustion and 57 (42%) reporting high depersonalisation. The clinical learning environment tool demonstrated a significant negative correlation with burnout (r=-0.56, P Burnout was significantly more common than when previously measured in Victoria in 2008 (62% versus 38%). Trainees rated examination preparation the most stressful aspect of the training program. There is a high prevalence of burnout among Victorian anaesthetic trainees. We have shown a significant correlation exists between the clinical learning environment measure and the presence of burnout. This correlation supports the development of interventions to improve the clinical learning environment, as a means to improve trainee wellbeing and address the high prevalence of burnout.

  7. Anaesthetic management of a patient with familial normokalaemic periodic paralysis.

    LENUS (Irish Health Repository)

    Walsh, F

    2012-02-03

    PURPOSE: We describe the anaesthetic management of a patient with the autosomal dominant inherited disease, normokalaemic periodic paralysis. The disease results in intermittent bouts of limb and respiratory muscular weakness in association with hypothermia, stress, prolonged fasting or exercise. Unlike hypokalaemic and hyperkalaemic periodic paralysis, the more common variants of the disease, normokalaemic periodic paralysis is not accompanied by alterations in the plasma potassium concentration. CLINICAL FEATURES: A five-year-old boy presented for emergency scrotal exploration. He had a family history of periodic paralysis and had experienced previous episodes of weakness, two of which had required hospitalization for respiratory distress. On admission there was no evidence of weakness and serum potassium concentration was 4.2 mMol.L-1. A spinal anaesthetic was performed and the procedure was uncomplicated by muscle paralysis above the level of the spinal block. CONCLUSION: Avoidance of known precipitating factors and judicious use of neuromuscular blocking drugs has been advocated in patients with this disorder presenting for surgery. In appropriate circumstances, spinal anaesthesia represents a useful option in patients with normokalaemic periodic paralysis.

  8. Learn More Breathe Better

    Centers for Disease Control (CDC) Podcasts

    2011-11-16

    Chronic obstructive pulmonary disease (COPD) is a serious lung disease that makes breathing very difficult and can affect your quality of life. Learn the causes of COPD and what you can do to prevent it.  Created: 11/16/2011 by National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health (NCCDPHP, DACH).   Date Released: 11/16/2011.

  9. [TMJ, eating and breathing].

    Science.gov (United States)

    Cheynet, F

    2016-09-01

    The study of the relationship between temporomandibular joints (TMJ), mastication and ventilation and the involvement of these two functions in the genesis of primary Temporomandibular Disorders (TMD) and in some dentofacial deformities, was initiated in France, more than 30years, by Professor Raymond Gola. Once criticized the weakness of the scientific literature in this domain, the originality of the TMJ within the masticatory system is recalled with its huge adaptation potential to very different biomechanical constraints according to the age and masticatory activities during the day. But the biomechanics of the masticatory system does not stop at night and the positions of the mandible and head during sleep should be studied carefully. In case of nocturnal mouth breathing with open mouth, the predominant sleeping position (generating small but long-term strengths) may be deleterious to the condyle-disc complex, to the surrounding muscles and the occlusal relationships. Some condyle-disc displacements and asymmetric malocclusions occur in this long portion of life what sleep, especially as oral breathing leads to a lot of dysfunctions (low position of the tongue, labio-lingual dysfunctions, exacerbation of bruxism sleep…). The aim of this work was to share our multidisciplinary experience of the biomechanical consequences of the nocturnal mouth breathing on the face involving orthodontists, maxillofacial surgeons, ENT, allergists, speech therapists, physiotherapists and radiologists. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. Hemodinâmica de diferentes frações inspiradas de oxigênio em cães submetidos à infusão contínua de propofol sob ventilação espontânea Hemodyinamic effects of several inspired oxygen fractions in spontaneously breathing dogs submitted to continuous infusion of propofol

    Directory of Open Access Journals (Sweden)

    Newton Nunes

    2008-06-01

    Full Text Available Avaliaram-se os efeitos do fornecimento de diferentes frações inspiradas de oxigênio (FiO2 sobre os parâmetros hemodinâmicos em cães submetidos à infusão contínua de propofol e mantidos em ventilação espontânea. Foram utilizados oito cães, os quais foram empregados em cinco grupos com diferentes FiO2, G100 (FiO2 = 1, G80 (FiO2 = 0,8, G60 (FiO2 = 0,6, G40 (FiO2 = 0,4 e G20 (FiO2 = 0,21, respeitando-se um intervalo de dez dias entre cada procedimento anestésico. Os animais foram induzidos e mantidos sob anestesia com propofol na dose de 0,7mg kg-1 min-1 e, após a intubação orotraqueal, iniciou-se o fornecimento de oxigênio conforme a FiO2 determinada para cada grupo. As primeiras mensurações, da freqüência cardíaca (FC, das pressões arteriais sistólica, diastólica e média (PAS, PAD e PAM, da resistência vascular periférica e pulmonar (RPT e RPV, do débito cardíaco (DC; da pressão venosa central (PVC, da pressão média da artéria pulmonar (PMAP, da pressão média capilar pulmonar (PMCP, da pressão parcial de oxigênio (PaO2 e do dióxido de carbono (PaCO2 no sangue arterial, foram efetuadas 30 minutos após o início da infusão do anestésico (M0, seguidas de intervalos de 15 minutos (M15, M30, M45 e M60. Os dados numéricos obtidos foram submetidos à Análise de Variância, seguida pelo teste Tukey (PThe effects of several inspired oxygen fractions (FiO2 in hemodynamics parameters in spontaneously breathing dogs submitted to continuous infusion of propofol were evaluated. Eight adult mongrel dogs were studied and the animals underwent five anesthesias. In each procedure the patient was submitted to a different FiO2, thereby resulting in five groups, namely: G100 (FiO2 = 1, G80 (FiO2 = 0.8, G60 (FiO2 =0.6, G40 (FiO2 = 0.4, and G20 (FiO2 = 0.21. The dose of propofol was sufficient to abolish protector reflex and ensure endotracheal intubation, followed by immediate continuous infusion of that drug (0.7mg kg-1

  11. [Evaluation of genotoxicity induced by repetitive administration of local anaesthetics: an experimental study in rats].

    Science.gov (United States)

    Nai, Gisele Alborghetti; de Oliveira, Mariliza Casanova; de Oliveira Tavares, Graziela; Pereira, Laís Fabrício Fonseca; Soares, Nádia Derli Salvador Lemes; Silva, Patrícia Gatti

    2015-01-01

    Previous studies regarding the effects of some local anaesthetics have suggested that these agents can cause genetic damage. However, they have not been tested for genotoxicity related to repetitive administration. The aim of this study was to evaluate the genotoxic potential of local anaesthetics upon repetitive administration. 80 male Wistar rats were divided into: group A - 16 rats intraperitoneally injected with lidocaine hydrochloride 2%; group B - 16 rats IP injected with mepivacaine 2%; group C - 16 rats intraperitoneally injected with articaine 4%; group D - 16 rats IP injected with prilocaine 3% (6.0mg/kg); group E - 8 rats subcutaneously injected with a single dose of cyclophosphamide; and group F - 8 rats intraperitoneally injected with saline. Eight rats from groups A to D received a single dose of anaesthetic on Day 1 of the experiment; the remaining rats were dosed once a day for 5 days. The median number of micronuclei in the local anaesthetics groups exposed for 1 or 5 days ranged from 0.00 to 1.00, in the cyclophosphamide-exposed group was 10.00, and the negative control group for 1 and 5 days was 1.00 and 0.00, respectively (plocal anaesthetic groups (p=0.0001), but not between the negative control group and the local anaesthetic groups (p>0.05). No genotoxicity effect was observed upon repetitive exposure to any of the local anaesthetics evaluated. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  12. Anaesthetic Management of Caesarean Section in an Achondroplastic Dwarf

    Directory of Open Access Journals (Sweden)

    Kirti N Saxena

    2008-01-01

    A twenty year old parturient with short stature presented to the hospital in early labour. An elective lower segment caesarean section(LSCS was planned in view of cephalopelvic disproportion. She had papers which suggested that she had been diagnosed as a case of achondroplasia though details were not available. Combined spinal epidural(CSE anaesthesia was planned in the patient in view of the death of her first baby following caesarean section under general anaesthesia. Repeatedly dry taps were achieved on attempting dural puncture. Dural puncture was abandoned and an 18 G epidural catheter was threaded via the Tuohy needle. Sensory block till T 6 was achieved with 6ml of local anaesthetic solution. The patient was stable during the intraoperative and postoperative period.

  13. Anaesthetic considerations for liver transplantation in propionic acidemia

    Directory of Open Access Journals (Sweden)

    Akila Rajakumar

    2016-01-01

    Full Text Available Propionic acidemia (PA is an autosomal recessive disorder of metabolism due to deficiency of the enzyme propionyl-CoA carboxylase (PCC that converts propionyl-CoA to methylmalonyl-CoA with the help of the cofactor biotin inside the mitochondria. The resultant accumulation of propionyl-CoA causes severe hyperammonaemia and life-threatening metabolic acidosis. Based on the positive outcomes, liver transplantation is now recommended for individuals with recurrent episodes of hyperammonaemia or acidosis that is not adequately controlled with appropriate medical therapies. We report anaesthetic management of two children with PA for liver transplantation at our institution. It is essential for the anaesthesiologist, caring for these individuals to be familiar with the manifestations of the disease, the triggers for decompensation and management of an acute episode.

  14. Anaesthetic considerations for liver transplantation in propionic acidemia.

    Science.gov (United States)

    Rajakumar, Akila; Kaliamoorthy, Ilankumaran; Reddy, Mettu Srinivas; Rela, Mohamed

    2016-01-01

    Propionic acidemia (PA) is an autosomal recessive disorder of metabolism due to deficiency of the enzyme propionyl-CoA carboxylase (PCC) that converts propionyl-CoA to methylmalonyl-CoA with the help of the cofactor biotin inside the mitochondria. The resultant accumulation of propionyl-CoA causes severe hyperammonaemia and life-threatening metabolic acidosis. Based on the positive outcomes, liver transplantation is now recommended for individuals with recurrent episodes of hyperammonaemia or acidosis that is not adequately controlled with appropriate medical therapies. We report anaesthetic management of two children with PA for liver transplantation at our institution. It is essential for the anaesthesiologist, caring for these individuals to be familiar with the manifestations of the disease, the triggers for decompensation and management of an acute episode.

  15. Regional haemodynamic effects of urocortin in the anaesthetized rat.

    Science.gov (United States)

    Abdelrahman, Aly M; Pang, Catherine C Y

    2003-04-18

    Urocortin is an endogenous vasodilator peptide that is related to corticotrophin-releasing factor. We examined the haemodynamic effects of urocortin in thiobutabarbital-anaesthetized rats, via the triple-isotope microspheres technique. Urocortin (3 nmol/kg, i.v. bolus) reduced mean arterial pressure (-25 mm Hg) through a decrease in total peripheral resistance (-43%). This was associated with an increase in cardiac output (+24%) and vasodilatation of the following tissues: heart and stomach (approximately 300% of baseline); liver, intestine, caecum/colon, skeletal muscle and skin (approximately 200%); and testes (approximately 150%). Arterial conductances of the kidneys, spleen and brain were unaffected by urocortin. Neither the vehicle (0.9% NaCl) nor a low dose of urocortin (0.3 nmol/kg) altered any measurements. Therefore, urocortin causes generalized vasodilatation as follows: heart and stomach>liver, intestine, caecum/colon, skeletal muscle and skin>testes.

  16. Prostaglandins release plasma 'reciprocal coupling factor' in anaesthetized rats.

    Science.gov (United States)

    Hoult, J. R.; Moore, P. K.

    1981-01-01

    1. Prostaglandins E1, E2, I2 and endoperoxide analogue U46619 injected intra-arterially (i.a.) into anaesthetized rats at 2 micrograms/kg caused a substantial increase within 60 min of the plasma activity of prostaglandin 'reciprocal coupling factor' (RCF). RCF is the provisional name for the component(s) of plasma which inhibit microsomal prostaglandin synthesis and enhance cytosolic prostaglandin breakdown. 2. RCF is not released by inactive metabolite 13,14-dihydro-15-keto prostaglandin E2 (10 micrograms/kg, i.a.) or acetylcholine or histamine (2 micrograms/kg, i.a.). 3. We suggest that release by prostaglandins of RCF would provide the basis in vivo for a negative feedback mechanism controlling the activity of the prostaglandin system. PMID:7032632

  17. Anaesthetic management of two different cases of mediastinal mass

    Directory of Open Access Journals (Sweden)

    Hemalatha Subbanna

    2013-01-01

    Full Text Available We report the management of two paediatric cases undergoing median sternotomy and right lateral thoracotomy for mediastinal mass. An 8-year-old boy presented with a history of intermittent fever and episodes of respiratory illness since 3 years and a 16-year-old girl presented with dyspnoea, cough, fever and dysphagia for solid foods. Radiological investigation confirmed the diagnoses. Absence of pressure symptoms pointed towards a compressible mass in the boy and indicated a non-compressible mass in the girl. We discuss the anaesthetic management of the younger patient with an uneventful course as opposed to the older patient where airway obstruction ensued soon after induction and led to near-cardiopulmonary arrest necessitating rescue measures. Swift measures at securing airway while simultaneously resuscitating the patient served to successfully revert an otherwise fateful eventuality.

  18. The effects of multiple anaesthetic episodes on equine recovery quality.

    Science.gov (United States)

    Platt, J P; Simon, B T; Coleman, M; Martinez, E A; Lepiz, M A; Watts, A E

    2018-01-01

    Although rare, 70% of equine fatalities during recovery from general anaesthesia (GA) are due to catastrophic fractures from poor recovery quality. To determine the effect of repeated GA recovery on GA recovery quality. Experimental blinded trial. Eight adult horses underwent six GA events on sevoflurane for distal limb MRI examination over a 14-week period. Prior to GA recovery, xylazine was administered. Randomly ordered video-recorded GA recoveries were scored by three blinded board certified veterinary anaesthesiologists, unaware of patient identity or GA event number, for nine parameters using a 100 mm visual analogue scale (VAS) where 0 = worst and 100 = best. The number of attempts to stand, duration of lateral and sternal recumbency, total recovery duration and physiologic parameters during each GA event were recorded. Repeated measures ANOVA were used to detect differences. Agreement between observer VAS scores was determined via inter-rater reliability using an intraclass correlation. With GA recovery experience, VAS scores for balance and coordination, knuckling, and overall quality of recovery were improved and the duration of lateral recumbency was increased. There were no differences in total recovery duration, number of attempts to stand, physiologic parameters other than heart rate during GA, or VAS scores for activity in lateral recumbency, move to sternal, move to stand, or strength. Each GA event was relatively short and there was no surgical stimulation. The same results may not occur if there was surgical stimulation and pain during each GA event. Recovery from GA improves with multiple anaesthetic episodes in horses. Clinicians can advise clients that horses are likely to have better GA recovery on repeated GA recovery due to improved balance and coordination and reduced knuckling. Additionally, there is no change in anaesthetic morbidity with six repeated GA events over a 14-week period. © 2017 EVJ Ltd.

  19. Interference of anaesthetics with radioligand binding in neuroreceptor studies

    Energy Technology Data Exchange (ETDEWEB)

    Elfving, Betina; Knudsen, Gitte Moos [Neurobiology Research Unit N9201, University hospital Rigshospitalet, 9 Blegdamsvej, 2100, Copenhagen (Denmark); Bjoernholm, Berith [Department of Computational Chemistry, H. Lundbeck A/S, Copenhagen-Valby (Denmark)

    2003-06-01

    Evaluations of new emission tomography ligands are usually carried out in animals. In order to keep the animals in a restricted position during the scan session, anaesthesia is almost inevitable. In ex vivo rat studies we investigated the interference of ketamine/xylazine, zoletile mixture, isoflurane and halothane with the serotonin re-uptake site, the serotonin{sub 2A} receptor and the dopamine re-uptake site by use of [{sup 3}H]-(S)-citalopram, [{sup 18}F]altanserin and [{sup 125}I]PE2I, respectively. Ketamine/xylazine decreased the target-to-background ratio (mean {+-} SD) of [{sup 3}H]-(S)-citalopram from 1.5{+-}0.19 to 0.81{+-}0.19 (P<0.05), whereas isoflurane and halothane increased the ratio from 1.5{+-}0.19 to 1.9{+-}0.24 and 2.1{+-}0.13 (P<0.05), respectively. Only with the zoletile mixture did the ratio remain unaltered. None of the tested anaesthetics affected the target-to-background ratio of [{sup 18}F]altanserin. The [{sup 125}I]PE2I target-to-background ratio decreased with both ketamine/xylazine (from 12.4{+-}0.81 to 10.1{+-}1.4, P<0.05) and isoflurane (from 12.4{+-}0.81 to 9.5{+-}1.1, P<0.05) treated rats, whereas treatment with zoletile mixture and halothane left the ratio unaltered. It is concluded that prior to performance of neuroreceptor radioligand studies, the possible interaction between radioligands and anaesthetics should be carefully evaluated. (orig.)

  20. The electrocardiogram of anaesthetized southern sea lion (Otaria flavescens) females.

    Science.gov (United States)

    Dassis, M; Rodríguez, D H; Rodríguez, E; Ponce de León, A; Castro, E

    2016-03-01

    The goal of this study was to characterize for the first time the electrocardiogram (ECG) of the southern sea lion (SSL) Otaria flavescens. Thirteen wild SSL females were captured at Isla de Lobos (Uruguay) and anaesthetized with isoflurane. Electrocardiographic recording was performed on anaesthetized animals at ventral recumbence following standardized procedures. The ECG recordings showed normal sinus rhythm. Amplitude and duration of P and T waves, QRS complex, PR interval, QT interval and ST segment (STS) were determined for all animals in all leads. QT corrected was determined in lead II. P wave polarity was consistent among animals (positive in LI, LII, LIII and AVF leads and negative in AVL and AVR leads for all animals), but T wave polarity did not present any constant pattern among animals, being either positive, negative or biphasic in different leads and different animals. The PR interval (0.15 ± 0.2 s) was similar to the allometric prediction for most of mammalian species including humans. The STS were normal in 10 of the SSL but showed STS depression in three of the animals. Almost all animals had a negative electrical axis (-30° to -120°), with one exception that showed a positive electrical axis (120°). Mean eupnoeic heart rate was 104.61 ± 10.06 (range = 88-120) beats per minute. This study was the first ECG description for this species, and provides valuable information for cardiac monitoring during anaesthesia. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. Anaesthetic accidents: an experience in sub-saharan Africa

    African Journals Online (AJOL)

    awaiting further oxygen therapy. However, poor breathing post-operatively despite good analgesia and adequate reversal, in the presence of continued unconsciousness necessitated re-intubation. Humidified oxygen was introduced via the ETT about 2 hrs later and this was continued for a further 48 hrs. When there was ...

  2. Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty: volume vs concentration

    DEFF Research Database (Denmark)

    Andersen, L Ø; Gaarn-Larsen, L; Kristensen, B B

    2010-01-01

    Wound administration of local anaesthetic may be effective for postoperative pain management in knee arthroplasty, but the analgesic efficacy of local anaesthetic in relation to volume vs concentration has not been determined. In a double-blinded trial, 48 patients scheduled for total knee...... was 12.5 (10-19 [0-35]) mg in the high volume/low concentration group, and 20 mg (16-40 [0-65]) mg in the low volume/high concentration group (p = 0.005). In conclusion, intracapsular administration of local anaesthetic may have limited analgesic efficacy with no volume vs concentration relationship...

  3. Foundation doctors in Anaesthesia: should they be taught to administer an anaesthetic?

    Directory of Open Access Journals (Sweden)

    Williamson Sean

    2007-11-01

    Full Text Available Abstract Background Anaesthetic pre-registration house officer posts have been available since 1997. With the change to postgraduate medical training introduced in 2005, these posts have become vital building blocks for Foundation Programmes. Discussion We debate the skills that new Foundation Programme doctors in such posts should be taught, particularly whether administration of an anaesthetic holds an important place. The opinion of college tutors prior to the institution of the foundation programme is included. These were obtained from a postal questionnaire. Summary We maintain that teaching how to administer an anaesthetic remains an important learning objective and something that should be actively pursued.

  4. 42 CFR 84.81 - Compressed breathing gas and liquefied breathing gas containers; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Compressed breathing gas and liquefied breathing... APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing Apparatus § 84.81 Compressed breathing gas and liquefied breathing gas containers; minimum requirements. (a) Compressed breathing gas and...

  5. Compressed breathing air - the potential for evil from within.

    Science.gov (United States)

    Millar, Ian L; Mouldey, Peter G

    2008-06-01

    Human underwater activities rely on an adequate supply of breathable compressed gas, usually air, free from contaminants that could cause incapacitation underwater or post-dive or longer-term health effects. Potentially fatal but well-known hazards are hypoxia secondary to steel cylinder corrosion and carbon monoxide (CO) poisoning due to contaminated intake air. Another phenomenon may be behind some previously unexplained episodes of underwater incapacitation and perhaps death: low-level CO poisoning and/or the effects of gaseous contaminants generated within the compressor, including toluene and other volatile compounds. Many low molecular weight volatile contaminants are anaesthetic and will be potentiated by pressure and nitrogen narcosis. In sub-anaesthetic doses, impaired judgement, lowered seizure threshold and sensitisation of the heart to arrhythmias may occur. Toxic compounds can be volatilised from some compressor oils, especially mineral oils, in overheated compressors, or be created de novo under certain combinations of temperature, humidity and pressure, perhaps catalysed by metal traces from compressor wear and tear. Most volatiles can be removed by activated carbon filtration but many filters are undersized and may overload in hot, moist conditions and with short dwell times. A compressor that passes normal testing could contaminate one or more cylinders after heating up and then return to producing clean air as the filters dry and the systems cool. The scope of this problem is very unclear as air quality is tested infrequently and often inadequately, even after fatalities. More research is needed as well as better education regarding the safe operation and limitations of high-pressure breathing air compressors.

  6. FMWC Radar for Breath Detection

    DEFF Research Database (Denmark)

    Suhr, Lau Frejstrup; Tafur Monroy, Idelfonso; Vegas Olmos, Juan José

    breathing through walls. Other remote breath tracking systems has been presented that are based on the Ultra-wideband radar technique. However, these systems have two drawbacks. Firstly, they penetrate walls. It is therefore harder to contain the emitted radiation and they could be used for unsolicited...

  7. Patient's breath controls comfort devices

    Science.gov (United States)

    Schrader, M.; Carpenter, B.; Nichols, C. D.

    1972-01-01

    Patient assist system for totally disabled persons was developed which permits a person, so paralyzed as to be unable to move, to activate by breathing, a call system to summon assistance, turn the page of a book, ajust his bed, or do any one of a number of other things. System consists of patient assist control and breath actuated switch.

  8. Investigation into breath meditation: Phenomenological ...

    African Journals Online (AJOL)

    This integral heuristic phenomenological investigation records participants' experiences of a single session of breath meditation with special reference to psychotherapy and sport psychology. There were 8 participants, 4 men and 4 women, with mean age of 45 years and age range from 31 to 62 years. Various breathing ...

  9. Personnel breathing zone sevoflurane concentration adherence to occupational exposure limits in conjunction with filling of vaporisers.

    Science.gov (United States)

    Heijbel, H; Bjurstöm, R; Jakobsson, J G

    2010-10-01

    Work place pollution during filling of anaesthetic vaporisers has been a matter of concern. We studied personnel breathing zone ambient air sevoflurane concentrations during filling of sevoflurane with three different filling systems: Quik-Fil™ for Abbott and Dräger Fill™ resp. Easy-Fil™ adapters for Baxter sevoflurane bottles, referred to as 'Abbott and Baxter filling systems'. Sequential filling of three vaporisers was performed for a 15-min period, once with each of Abbott and Baxter filling systems, by four nurses. Ambient-air sevoflurane p.p.m. concentration in the breathing zone was continuously measured using a Miran 1a device during filling, and the mean 15 min sevoflurane concentration was calculated. All eight measured (4 × 2 sequences) 15-min mean breathing zone sevoflurane concentrations covering filling of three vaporisers were well below the recommended short-term value (STV) provided by the Swedish Work Environment Authority (STV 20 p.p.m.). The breathing zone sevoflurane concentration during filling of sevoflurane with Baxter or Abbott filling systems, in an ordinary operating theatre, was found to be reassuringly below the Swedish recommended STV (20 p.p.m. average for a 15-min period).

  10. Assessment of anaesthetic depth by clustering analysis and autoregressive modelling of electroencephalograms

    DEFF Research Database (Denmark)

    Thomsen, C E; Rosenfalck, A; Nørregaard Christensen, K

    1991-01-01

    The brain activity electroencephalogram (EEG) was recorded from 30 healthy women scheduled for hysterectomy. The patients were anaesthetized with isoflurane, halothane or etomidate/fentanyl. A multiparametric method was used for extraction of amplitude and frequency information from the EEG...

  11. In vitro toxicity of local anaesthetics and corticosteroids on supraspinatus tenocyte viability and metabolism

    Directory of Open Access Journals (Sweden)

    Clayton W. Nuelle

    2017-01-01

    Conclusion: This data confirms that peritendinous injection of commonly used local anaesthetics and corticosteroids results in significant supraspinatus tenotoxicity in vitro. Further in vivo studies are required before making definitive clinical recommendations.

  12. The analgesic effect of wound infiltration with local anaesthetics after breast surgery

    DEFF Research Database (Denmark)

    Byager, N; Hansen, Mads; Mathiesen, Ole

    2014-01-01

    significant reduction in post-operative, supplemental opioid consumption that was, however, of limited clinical relevance. CONCLUSION: Wound infiltration with local anaesthetics may have a modest analgesic effect in the first few hours after surgery. Pain after breast surgery is, however, generally mild......BACKGROUND: Wound infiltration with local anaesthetics is commonly used during breast surgery in an attempt to reduce post-operative pain and opioid consumption. The aim of this review was to evaluate the effect of wound infiltration with local anaesthetics compared with a control group on post......-operative pain after breast surgery. METHODS: A systematic review was performed by searching PubMed, Google Scholar, the Cochrane database and Embase for randomised, blinded, controlled trials of wound infiltration with local anaesthetics for post-operative pain relief in female adults undergoing breast surgery...

  13. Cutaneous stimulation and generation of breathing in the fetus.

    Science.gov (United States)

    Scarpelli, E M; Condorelli, S; Cosmi, E V

    1977-01-01

    The generation of spontaneous regular breathing by cutaneous stimulation and by direct electrical stimulation of the sciatic nerve was examined in six previously apneic mature fetal lambs in utero. The fetuses were stable throughout the course of the experiments: PaO2 less than or equal to 27 mm Hg, PaCO2 less than 44 mm Hg, pH 7.29-7.34, blood pressure and heart rate steady and normal. It is shown that electrical stimulation of the fetal skin (66 cps, 4.0 msec, 6 V, 0.77 ma) can be as effective as direct stimulation of the sciatic nerve (66 cps, 4.0 msec, 1.5 V, 0.08 ma) when the higher voltage and current are used. Mechanical cutaneous stimulation also produced spontaneous breathing which, however, was short lived compared with that produced by electrical stimuli. The results are consonant with our concept of activation and recruitment of quiescent respiratory center neurones by somatic sensory stimulation, and they give fundamental support to the clinical observation of others that cutaneous stimulation is effective for the treatment of apnea of prematurity. Speculation Somatic sensory stimuli from the skin may be important determinants of the onset of breathing in the fetus and newborn.

  14. Anaesthetic management of a child with panthothenate kinase-associated neurodegeneration

    Directory of Open Access Journals (Sweden)

    Renu Sinha

    2015-01-01

    Full Text Available Panthothenate kinase-associated neurodegeneration (PKAN (Hallervorden-Spatz disease is a rare autosomal recessive chromosomal disorder characterised by progressive neuroaxonal dystrophy. The characteristic features include involuntary movements, rigidity, mental retardation, seizures, emaciation. The anaesthetic concerns include difficult airway, aspiration pneumonia, dehydration, and post-operative respiratory, and renal insufficiency. We report successful anaesthetic management of a 9-year-old intellectually disabled male child with PKAN, scheduled for ophthalmic surgery under general anaesthesia.

  15. Anaesthetic significance and management of a child with neonatal purpura fulminans

    Directory of Open Access Journals (Sweden)

    Akhilesh Kumar Tiwari

    2012-01-01

    Full Text Available Protein C deficiency is a rare autosomal-dominant disorder of varying severity. Patients with homozygous and compound heterozygous protein C deficiency present with neonatal purpura fulminans (NPF. Other presentations usually include disseminated intravascular coagulation and venous thromboembolism. This disorder usually poses a unique anaesthetic challenge to the anaesthesiologist, requiring special precautions to prevent various intra- and post-operative complications. We hereby report the successful anaesthetic management of a 1-month-old infant who presented with NPF.

  16. Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty: volume vs concentration

    DEFF Research Database (Denmark)

    Andersen, L Ø; Gaarn-Larsen, L; Kristensen, B B

    2010-01-01

    Wound administration of local anaesthetic may be effective for postoperative pain management in knee arthroplasty, but the analgesic efficacy of local anaesthetic in relation to volume vs concentration has not been determined. In a double-blinded trial, 48 patients scheduled for total knee...... was reduced in both groups with ropivacaine administration 24 h postoperatively (p observed with ropivacaine injection 6 h postoperatively. The median (IQR [range]) dose of oxycodone administered...

  17. Role of Human Factors and Non-Technical Skills in Anaesthetic Nursing Practice: A Case Study

    OpenAIRE

    Martin, Daphne; Melarkey, Noelle; Hoy, Leontia

    2018-01-01

    The role of the anaesthetic nurse specialist is about to change and the adaptation, consisting of many skills including educator, advisor, change agent and innovator. Expertise, knowledge and skills acquired, range not only from years of experience but now through a m ore formal educational specialist pathway at graduate level. The anaesthetic specialised role is to enhance patient outcomes and experience by delivering individually tailored care in the perioperative phase. The need to improve...

  18. Breath of hospitality.

    Science.gov (United States)

    Škof, Lenart

    2016-12-01

    In this paper we outline the possibilities of an ethic of care based on our self-affection and subjectivity in the ethical spaces between-two. In this we first refer to three Irigarayan concepts - breath, silence and listening from the third phase of her philosophy, and discuss them within the methodological framework of an ethics of intersubjectivity and interiority. Together with attentiveness, we analyse them as four categories of our ethical becoming. Furthermore, we argue that self-affection is based on our inchoate receptivity for the needs of the other(s) and is thus dialectical in its character. In this we critically confront some epistemological views of our ethical becoming. We wind up this paper with a proposal for an ethics towards two autonomous subjects, based on care and our shared ethical becoming - both as signs of our deepest hospitality towards the other.

  19. Efficacy of paediatric anaesthetic trolleys: A call for a basic standard and layout.

    Science.gov (United States)

    Griffiths, Sian E; Boleat, Elizabeth; Goodwin, Alison; Sheikh, Asme; Goonasekera, Chulananda

    2015-01-01

    Providing safe anaesthesia to children especially in emergency situations goes hand in hand with instant availability of appropriately sized equipment and monitoring. This is best achieved using a designated paediatric anaesthetic trolley containing essential equipment. Guidance for the contents of such trolleys is neither explicit nor standard. We used a survey and a qualitative enquiry to develop a checklist suitable for standardisation of contents and layout of paediatric anaesthetic trolleys. We conducted an observational study of our current practice and paediatric anaesthetic trolleys in a tertiary care hospital. We also performed a qualitative enquiry from experienced paediatric anaesthetists and operating department practitioners.We developed an empirical checklist to ensure the minimum 'essential' equipment is available on these trolleys and implemented a standard layout to facilitate its use. We identified 11 areas in our hospital where anaesthesia is provided to children, each with a designated paediatric anaesthetic trolley. There were considerable deficiencies of items in all areas with no standard pattern or layout. Different types of trolleys contributed to the confusion. In addition, overstocking of inappropriate items hindered its efficient use. Standardising the contents and layout of the paediatric anaesthetic trolley is an essential pre-requisite for safer paediatric anaesthetic practice.

  20. The cardiovascular and respiratory effects of medetomidine and thiopentone anaesthesia in dogs breathing at an altitude of 1486 m

    Directory of Open Access Journals (Sweden)

    K. E. Joubert

    2002-07-01

    Full Text Available The purpose of this study was to evaluate the cardio-respiratory effects of the combination of medetomidine and thiopentone followed by reversal with atipamezole as a combination for anaesthesia in 10 healthy German Shepherd dogs breathing spontaneously in a room at an altitude of 1486 m above sea level with an ambient air pressure of 651 mmHg. After the placement of intravenous and intra-arterial catheters, baseline samples were collected. Medetomidine (0.010 mg/kg was administered intravenously and blood pressure and heart rate were recorded every minute for 5 minutes. Thiopentone was then slowly administered until intubation conditions were ideal. An endotracheal tube was placed and the dogs breathed room air spontaneously. Blood pressure, pulse oximetry, respiratory and heart rate, capnography, blood gas analysis and arterial lactate were performed or recorded every 10 minutes for the duration of the trial. Thiopentone was administered to maintain anaesthesia. After 60 minutes, atipamezole (0.025 mg/kg was given intramuscularly. Data were recorded for the next 30 minutes. A dose of 8.7 mg/kg of thiopentone was required to anaesthetise the dogs after the administration of 0.010 mg/kg of medetomidine. Heart rate decreased from 96.7 at baseline to 38.5 5 minutes after the administration of medetomidine (P < 0.05. Heart rate then increased with the administration of thiopentone to 103.2 (P < 0.05. Blood pressure increased from 169.4/86.2 mmHg to 253.2/143.0 mmHg 5 minutes after the administration of medetomidine (P < 0.05. Blood pressure then slowly returned towards normal. Heart rate and blood pressure returned to baseline values after the administration of atipamezole. Arterial oxygen tension decreased from baseline levels (84.1 mmHg to 57.8 mmHg after the administration of medetomidine and thiopentone (P < 0.05. This was accompanied by arterial desaturation from 94.7 to 79.7 % (P < 0.05. A decrease in respiratory rate from 71.8 bpm to 12

  1. Periodic breathing in healthy humans at exercise in hypoxia.

    Science.gov (United States)

    Hermand, Eric; Pichon, Aurélien; Lhuissier, François J; Richalet, Jean-Paul

    2015-01-01

    Periodic breathing is frequent in heart failure or ventilatory disorders during sleep, and common during sleep at high altitude, but has been rarely studied in wakefulness and during exercise. A retrospective analysis of ventilation from hypoxia exercise tests was realized in 82 healthy subjects separated into two groups with either high or low ventilatory response to hypoxia at exercise (HVRe). A fast Fourier transform spectral analysis of the breath-by-breath ventilation (V̇e) signal, O2 saturation, and end-tidal PCO2 evidenced a periodic pattern with a period of 11.1 to 12.0 s. The peak power of the V̇e spectrum was higher in the high HVRe group (P hypoxia (0 to 4,000 m altitude). The period of V̇e was shorter at exercise (vs. rest, P hypoxia (vs. normoxia, P hypoxia (P hypoxia was positively related with the ventilatory response to CO2 (HCVR). This novel observation suggests that healthy subjects demonstrate a spontaneous periodic breathing, not clearly observable at rest and in normoxia, but triggered by hypoxic exercise. The periodic pattern is enhanced in subjects with high HVRe and high HCVR, suggesting that oxygen and CO2 play synergistic roles in the modulation of these oscillations. Copyright © 2015 the American Physiological Society.

  2. Spontaneous uterine rupture

    African Journals Online (AJOL)

    ABSTRACT. Rupture of a gravid uterus is a surgical emergency. Predisposing factors include a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present the case of a spontaneous complete uterine rupture at a gestational age of 34 weeks in a 35 year old patient ...

  3. Spontaneous intracranial hypotension.

    LENUS (Irish Health Repository)

    Fullam, L

    2012-01-31

    INTRODUCTION: Spontaneous\\/primary intracranial hypotension is characterised by orthostatic headache and is associated with characteristic magnetic resonance imaging findings. CASE REPORT: We present a case report of a patient with typical symptoms and classical radiological images. DISCUSSION: Spontaneous intracranial hypotension is an under-recognised cause of headache and can be diagnosed by history of typical orthostatic headache and findings on MRI brain.

  4. Pancreatic exocrine responses to parasympathetic stimulation in anaesthetized pigs.

    Science.gov (United States)

    Halfacree, Z J; Read, P A; Edwards, A V

    2001-03-23

    Pancreatic exocrine responses to stimulation of the peripheral ends of the vagus nerves intermittently have been investigated in anaesthetized pigs and compared with the effects of continuous stimulation at corresponding frequencies. At relatively low frequencies Hz in bursts or 2 Hz continuously) both the flow of pancreatic juice and the output of protein therein were potentiated by stimulating in bursts. Thus stimulation at 20 Hz in bursts produced a significantly greater flow of pancreatic juice than stimulation at 2 Hz continuously (10.9+/-0.9 compared to 4.8+/-0.7 microl min(-1) (g gland)-1 , respectively; PHz (144+/-23 microg min(-1) (g gland)-1) far exceeded that produced during continuous stimulation at 2 Hz (49+/-9 microg min(-1) (g gland)-1; PHz) and substantially reduced the output of protein during intermittent stimulation (to 27+/-7 ng min(-1) (g gland)-1; PHz in bursts). These results show that a variety of pancreatic exocrine responses can be enhanced by stimulating the parasympathetic innervation in bursts. They are also consistent with the contention that the secretion of protein from the gland, in response to parasympathetic stimulation, is dependent mainly on activation of muscarinic receptors. They confirm that the flow of pancreatic juice is due mainly to the release of VIP and show that, in the absence of atropine, this is restricted by muscarinic inhibition which may be presynaptic as elsewhere.

  5. Nasogastric tube insertion in anaesthetized patients: a comprehensive review.

    Science.gov (United States)

    Sanaie, Sarvin; Mahmoodpoor, Ata; Najafi, Mahdi

    2017-01-01

    Nasogastric tubes (NGT) still remain the easiest and the best way for gastrointestinal tract access. There are various indications for the insertion of a nasogastric tube in anaesthetized and critically ill patients. Although many techniques have been introduced to facilitate nasogastric tube insertion using anatomic landmarks and a group of devices, there is no consensus on a standard method. Moreover, there are different methods for the assessment of the correct placement of a nasogastric tube. In addition to these challenges in insertion and assessment methods, there are varieties of major life-threatening and minor complications to be addressed. Thus, selecting the most appropriate approach requires enough knowledge in this area, considering patient condition and clinical factors, as well as the practitioners' sufficient education and experience, along with skill in performance. This is a comprehensive review of the literature evidence on different methods for nasogastric tube insertion, on the assessment of correct placement and the evaluation of complications, in addition to an approach to the effect of education on the quality of routine practice and patients' outcome.  .

  6. Volatile anaesthetics and cardiac protection in abdominal surgery.

    Science.gov (United States)

    Kopić, Jasminka

    2015-07-01

    Clinical studies have shown that sevoflurane is cardio-protective in cardiac surgery patients, but this effect is doubtful in general surgery patients. This study has researched the influence of sevoflurane on the perioperative cardiac function and the incidence of cardiac ischaemic events in abdominal surgical patients. Out of 80 patients scheduled for elective colorectal surgery, 42 received balanced sevoflurane-fentanyl anaesthesia, while 38 received intravenous midazolam-fentanyl anaesthesia. The cardiac index (CI) and cardiac function index (CFI) were measured by the PiCCO device, and Troponin I levels were measured at the beginning of surgery, as well as 4, 12 and 24 h afterwards. BNP was measured at the beginning of surgery, and 24 h afterwards. The data analysis was conducted using the Mann-Whitney nonparametric test, with statistical significance set at p abdominal surgical patients. Further research on the preconditioning effect of volatile anaesthetics in general surgical population should be concentrated on the population of patients with a high perioperative cardiac risk.

  7. Patients' Reactions to Local Anaesthetic Application Devices in Paediatric Dentistry.

    Science.gov (United States)

    Bajrić, Elmedin; Kobasglija, Sedin; Jurić, Hrvoje

    2015-09-01

    Local anaesthesia is the most common medium for pain control in most dental treatments. Physical appearance of syringe itself can be considered as a provoking factor for the emergence of dental fear and anxiety (DFA). In this research the patient reactions to local anaesthesia application devices, as one of the main causes for DFA emergence, were inquired. The sample comprised of 120 patients, divided in three age groups, formed of 40 patients aged 8, 12 and 15 years. DFA prevalence was quantified by Children Fear Survey Schedule-Dental Subscale (CFSS-DS). Three different syringes were offered to the patients. Reasons for choosing one of the syringes were detected. Patients assigned statistically highest rank to plastic syringe. Boys chose metal and intraligamental syringe statistically more often than girls. Patients with higher CFSS-DS scores chose metal syringe as last option. None of the reasons for selection was dominant, except pain that could be caused by usage of any of the three syringes. A large number of patients did not mention any of the reasons for choosing particular syringes. Plastic syringe represented the most acceptable device for local anaesthetic application to our patients. Patients often linked pain with dental syringes.

  8. A review of an anaesthetic led vascular access list.

    Science.gov (United States)

    Galloway, S; Sharma, A; Ward, J; Bodenham, A R

    2005-08-01

    The demand for insertion of long-term central venous (Hickman type) catheters is thought to be increasing. Organisation is required to meet this demand in a safe and efficient manner. This report reviews the results from a dedicated, anaesthetic led vascular access list over the initial 61-month period. One thousand procedures were performed. Nine hundred and twenty catheters were inserted under local anaesthesia, with or without intravenous sedation and analgesia. Eighty catheters were removed. All procedures were performed during a dedicated once weekly, morning list. A total of 53% of all procedures were performed on a day-case basis, 43% on in-patients. Only 1.5% of patients required an unexpected overnight stay (usually medically unfit patients). There were 81 (9%) cancellations on the day of procedure due to neutropaenia, pneumonia or urinary tract infections. Ultrasound guidance was used initially selectively in 14%, latterly in 100% of procedures and fluoroscopy in all insertions to confirm or adjust catheter position. This service has been well received by patients and oncology services. In addition it provides an interesting area of practice for anaesthetists and an ideal environment for teaching more advanced aspects of central venous access. It may provide a template of service for other centres.

  9. Anaesthetic management of a case of neonatal tetanus undergoing ...

    African Journals Online (AJOL)

    The patient was given a diazepam based general anaesthesia with muscle relaxation and manually ventilated with 70% oxygen in air. Oxygen saturation, pulse, temperature and blood pressure were maintained at stable levels during the operation which lasted two and half hours. Early recovery of spontaneous respiration ...

  10. Diverse presentation of breath holding spells: two case reports with literature review.

    Science.gov (United States)

    Rathore, Geetanjali; Larsen, Paul; Fernandez, Cristina; Parakh, Manish

    2013-01-01

    Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breathholding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. Spontaneous resolution of breath-holding spells is usually seen, without any adverse developmental and intellectual sequelae. Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. Reassurance and education is the mainstay of therapy. Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit. Here we present 2 cases, one of each, pallid and cyanotic breath holding spells.

  11. Diverse Presentation of Breath Holding Spells: Two Case Reports with Literature Review

    Directory of Open Access Journals (Sweden)

    Geetanjali Rathore

    2013-01-01

    Full Text Available Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breathholding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. Spontaneous resolution of breath-holding spells is usually seen, without any adverse developmental and intellectual sequelae. Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. Reassurance and education is the mainstay of therapy. Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit. Here we present 2 cases, one of each, pallid and cyanotic breath holding spells.

  12. Diverse Presentation of Breath Holding Spells: Two Case Reports with Literature Review

    Science.gov (United States)

    Rathore, Geetanjali; Larsen, Paul; Fernandez, Cristina; Parakh, Manish

    2013-01-01

    Breath holding spells are a common and dramatic form of syncope and anoxic seizure in infancy. They are usually triggered by an emotional stimuli or minor trauma. Based on the color change, they are classified into 3 types, cyanotic, pallid, and mixed. Pallid breath holding spells result from exaggerated, vagally-mediated cardiac inhibition, whereas the more common, cyanotic breathholding spells are of more complex pathogenesis which is not completely understood. A detailed and accurate history is the mainstay of diagnosis. An EKG should be strongly considered to rule out long QT syndrome. Spontaneous resolution of breath-holding spells is usually seen, without any adverse developmental and intellectual sequelae. Rare cases of status epilepticus, prolonged asystole, and sudden death have been reported. Reassurance and education is the mainstay of therapy. Occasionally, pharmacologic intervention with iron, piracetam; atropine may be of benefit. Here we present 2 cases, one of each, pallid and cyanotic breath holding spells. PMID:24191206

  13. Practice It: Deep Conscious Breathing Exercise

    Science.gov (United States)

    No time to sit and breathe? No problem; take your breathing practice with you! Deep conscious breathing can also be done with the eyes open wherever you happen to be—simply pause and take two to three full deep breaths (inhale deeply and exhale completely).

  14. Genotoxicity and cytotoxicity of cisplatin treatment combined with anaesthetics on EAT cells in vivo.

    Science.gov (United States)

    Brozovic, Gordana; Orsolic, Nada; Knezevic, Fabijan; Horvat Knezevic, Anica; Benkovic, Vesna; Sakic, Katarina; Hrgovic, Zlatko; Bendelja, Kreso; Fassbender, Walter J

    2009-06-01

    In this study, DNA damage in tumour cells, as well as irreversible cell damage leading to apoptosis induced in vivo by the combined application of cisplatin and inhalation anaesthetics, was investigated. The genotoxicity of anaesthetics on Ehrlich ascites tumour (EAT) cells of mice, alone or in combined application with cisplatin, was estimated by using the alkaline comet assay. The percentage of EAT cell apoptosis was quantified by flow cytometry. Groups of EAT-bearing mice were (i) treated intraperitoneally with cisplatin, (ii) exposed to repeated anaesthesia with inhalation anaesthetic, and (iii) subjected to combined treatment of exposure to anaesthetics after cisplatin for 3 days. Sevoflurane, halothane and isoflurane caused strong genotoxic effects on tumour cells in vivo. The tested anaesthetics alone showed no direct effect on programmed cell death although sevoflurane and especially halothane decreased the number of living EAT cells in peritoneal cavity lavage. Repeated anaesthesia with isoflurane had stimulatory effects on EAT cell proliferation and inhibited tumour cell apoptosis (6.11%), compared to the control group (10.26%). Cisplatin caused massive apoptosis of EAT cells (41.14%) and decreased the number of living EAT cells in the peritoneal cavity. Combined cisplatin and isoflurane treatment additionally increased EAT cell apoptosis to 51.32%. Combined treatment of mice with cisplatin and all anaesthetics increased the number of living tumour cells in the peritoneal cavity compared to cisplatin treatment of mice alone. These results suggest that the inhalation of anaesthetics may protect tumour cells from the cisplatin-induced genotoxic and cytotoxic effects. Copyright 2009 S. Karger AG, Basel.

  15. Comparative efficacy and patient preference of topical anaesthetics in dermatological laser treatments and skin microneedling

    Directory of Open Access Journals (Sweden)

    Yi Zhen Chiang

    2015-01-01

    Full Text Available Background: Topical anaesthetics are effective for patients undergoing superficial dermatological and laser procedures. Our objective was to compare the efficacy and patient preference of three commonly used topical anaesthetics: (2.5% lidocaine/2.5% prilocaine cream (EMLA ® , 4% tetracaine gel (Ametop TM and 4% liposomal lidocaine gel (LMX4 ® in patients undergoing laser procedures and skin microneedling. Settings and Design: This was a prospective, double-blind study of patients undergoing laser and skin microneedling procedures at a laser unit in a tertiary referral dermatology centre. Materials and Methods: All 29 patients had three topical anaesthetics applied under occlusion for 1 hour prior to the procedure, at different treatment sites within the same anatomical zone. A self-assessment numerical pain rating scale was given to each patient to rate the pain during the procedure and each patient was asked to specify their preferred choice of topical anaesthetic at the end of the procedure. Statistical Analysis: Parametric data (mean pain scores and frequency of topical anaesthetic agent of choice were compared using the paired samples t-test. A P-value of ≤0.05 was considered as statistically significant. Results and Conclusions: Patients reported a mean (±SD; 95% confidence interval pain score of 5 (±2.58; 3.66-6.46 with Ametop TM , 4.38 (±2.53; 2.64-4.89 with EMLA ® and 3.91 (±1.95; 2.65-4.76 with LMX4 ® . There was no statistically significant difference in pain scores between the different topical anaesthetics. The majority of patients preferred LMX4 ® as their choice of topical anaesthetic for dermatological laser and skin microneedling procedures.

  16. Visualizing Breath using Digital Holography

    Science.gov (United States)

    Hobson, P. R.; Reid, I. D.; Wilton, J. B.

    2013-02-01

    Artist Jayne Wilton and physicists Peter Hobson and Ivan Reid of Brunel University are collaborating at Brunel University on a project which aims to use a range of techniques to make visible the normally invisible dynamics of the breath and the verbal and non-verbal communication it facilitates. The breath is a source of a wide range of chemical, auditory and physical exchanges with the direct environment. Digital Holography is being investigated to enable a visually stimulating articulation of the physical trajectory of the breath as it leaves the mouth. Initial findings of this research are presented. Real time digital hologram replay allows the audience to move through holographs of breath-born particles.

  17. Interaction of local and general anaesthetics with liposomal membrane models: a QCM-D and DSC study.

    Science.gov (United States)

    Paiva, José Gabriel; Paradiso, Patrizia; Serro, Ana Paula; Fernandes, Anabela; Saramago, Benilde

    2012-06-15

    The behaviour of four local anaesthetics (lidocaine, levobupivacaine, ropivacaine and tetracaine) and one general anaesthetic (propofol) is compared when interacting with two types of model membranes: supported layers of liposomes and liposomes in solution. Several liposomal compositions were tested: dimyristoylphosphatidylcholine (DMPC), binary mixtures of DMPC with cholesterol (CHOL), and ternary mixtures of dipalmitoylphosphatidylcholine (DPPC), DMPC, and CHOL. A quartz crystal microbalance with dissipation, QCM-D, was used to assess changes in the properties of supported layers of liposomes. The effect of the anaesthetics on the phase behaviour of the liposomes in suspension was determined by differential scanning calorimetry. Both techniques show that all anaesthetics have a fluidizing effect on the model membranes but, apparently, the solid supported liposomes are less affected by the anaesthetics than the liposomes in solution. Although the different anaesthetics were compared at different concentrations, tetracaine and propofol seem to induce the strongest perturbation on the liposome membrane. The resistance of the liposomes to the anaesthetic action was found to increase with the presence of cholesterol, while adding DPPC to the binary mixture DMPC+CHOL does not change its behaviour. The novelty of the present work resides upon three points: (1) the use of supported layers of liposomes as model membranes to study interactions with anaesthetics; (2) application of QCM-D to assess changes of the adsorbed liposomes; (3) a comparison of the effect of local and general anaesthetics interacting with various model membranes in similar experimental conditions. Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Blue breath holding is benign.

    OpenAIRE

    Stephenson, J B

    1991-01-01

    In their recent publication in this journal, Southall et al described typical cyanotic breath holding spells, both in otherwise healthy children and in those with brainstem lesions and other malformations. Their suggestions regarding possible autonomic disturbances may require further study, but they have adduced no scientific evidence to contradict the accepted view that in the intact child blue breath holding spells are benign. Those families in which an infant suffers an 'apparently life t...

  19. Enhanced non-eupneic breathing following hypoxic, hypercapnic or hypoxic-hypercapnic gas challenges in conscious mice.

    Science.gov (United States)

    Getsy, Paulina M; Davis, Jesse; Coffee, Gregory A; May, Walter J; Palmer, Lisa A; Strohl, Kingman P; Lewis, Stephen J

    2014-12-01

    C57BL6 mice display non-eupneic breathing and spontaneous apneas during wakefulness and sleep as well as markedly disordered breathing following cessation of a hypoxic challenge. We examined whether (1) C57BL6 mice display marked non-eupneic breathing following hypercapnic or hypoxic-hypercapnic challenges, and (2) compared the post-hypoxia changes in non-eupneic breathing of C57BL6 mice to those of B6AF1 (57BL6 dam × A/J sire) and Swiss-Webster mice, which display different ventilatory responses than C57BL6 mice. C57BL6 mice displayed marked increases in respiratory frequency and non-eupneic breathing upon return to room-air after hypoxic (10% O2, 90% N2), hypercapnic (5% CO2, 21% O2 and 74% N2) and hypoxic-hypercapnic (10% O2, 5% CO2 and 85% N2) challenges. B6AF1 mice displayed less tachypnea and reduced non-eupneic breathing post-hypoxia, whereas Swiss-Webster mice displayed robust tachypnea with minimal increases in non-eupneic breathing post-hypoxia. These studies demonstrate that non-eupneic breathing increases after physiologically-relevant hypoxic-hypercapnic challenge in C57BL6 mice and suggest that further studies with these and B6AF1 and Swiss-Webster mice will help define the genetics of non-eupneic breathing. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. The perils of dental vacation: possible anaesthetic and medicolegal consequences.

    Science.gov (United States)

    Feltracco, Paolo; Gaudio, Rosa Maria; Barbieri, Stefania; Tiano, Letizia; Iacobone, Maurizio; Viel, Giovanni; Tonetti, Tommaso; Galligioni, Helmut; Bortolato, Andrea; Ori, Carlo; Avato, Francesco Maria

    2013-01-01

    The aim of this paper is to emphasize anaesthesiologists' difficulty in detecting poor dentition in cases of poorly applied prostheses and/or advanced periodontal disease, and to establish whether it is possible, and in which conditions, to calculate compensation in cases of dental damage postlaryngoscopy and/or intubation. The main complex problem here lies in trying to reconstruct exactly what the dental situation was before the teeth were damaged. For this reason the important preoperative factors (dental prostheses, crown fractures, parodontal disease, etc.) must be clearly shown before surgery on a dental chart. Two cases of interest, both to anaesthesiologists practising intubation and medicolegal physicians who have to deal with potential claims, are briefly reported. The first patient was a 55-year-old diabetic patient, who underwent emergency surgery for acute abdominal pathology. He had gone outside Italy for dental treatment three years previously and now presented with very poor pre-existing dentition, carefully noted on an anaesthetic chart. He now demanded compensation for dental damage due to intubation in Italy; the resulting dental treatment was very expensive because substantial remedial work was required. The second patient had received treatment outside Italy, work which involved cosmetic coating of the teeth. After surgery in Italy, she demanded compensation because one tooth, which had been coated and appeared to be healthy, was broken after emergency intubation. In both cases, the patients demanded very high compensation. Dental tourism alone accounts for more than 250,000 patients each year who combine a holiday with dental treatment in Eastern Europe. However, if prosthetic devices or conservative treatments are not applied correctly, it should be noted that durability may be poorer than expected, but iatrogenic damage may also be caused.

  1. The effects of cremophor EL in the anaesthetized dog.

    Science.gov (United States)

    Gaudy, J H; Sicard, J F; Lhoste, F; Boitier, J F

    1987-03-01

    The effects of cremophor EL were studied in 13 anaesthetized, paralyzed and ventilated dogs. Twenty per cent cremophor EL in a dose of 4.3 +/- 0.92 ml was infused at a rate of 30 ml X hr-1. In seven dogs, thoracopulmonary compliance, heart rate, systemic arterial pressure (SAP), pulmonary pressures (PAP, PCWP, RAP), cardiac output (CO) and platelet and white cell counts, were measured before the injection of cremophor EL, at the end of infusion and 5, 10, 30 and 150 minutes after the end of infusion. In six dogs, SAP, CO, and blood volume were measured before the injection of cremophor EL, at the end of infusion and 10, 30, 90 and 150 minutes after the end of infusion. Plasma histamine and catecholamines were assayed before the injection of cremophor EL and 2, 5, 10, 30, 90 and 150 minutes after starting the infusion. Cremophor EL induced a marked, sustained and significant decrease in SAP at the end of infusion and at 5, 10 and 30 minutes after the completion of the infusion (-68, -71, -70 and -43 per cent respectively), in PCWP, RAP and CO (-78 per cent at the end of infusion, -32 per cent 150 minutes after the end of infusion). Heart rate and systemic vascular resistance did not vary significantly. Pulmonary vascular resistance increased at the end of infusion, five and ten minutes after the end of infusion (+734, +548 and +439 per cent respectively). Plasma volume decreased 10 and 30 minutes after the end of infusion (-28 and -30.5 per cent respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Post-anaesthetic myelomalacia in a horse : clinical communication

    Directory of Open Access Journals (Sweden)

    K.E. Joubert

    2005-06-01

    Full Text Available This article describes a rare neurological complication of anaesthesia in a 2 year-old Clydesdale colt undergoing castration. Anaesthesia was induced with glyceryl guaiacol ether and ketamine and maintained with halothane. Following an uneventful anaesthetic of 40 minutes, the horse recovered from anaesthesia in a padded recovery stall. After approximately 70 minutes in the recovery stall, the horse attempted to stand and adopted a dog sitting position. One hundred and fifty minutes later, the horse became distressed and was sedated with xylazine. Clinical examination of the horse did not reveal any evidence of myositis or fractures. A neurological examination revealed an intact anal reflex, deep pain response in the hind legs, tail tone and voluntary movement of the hind legs was possible. The horse deteriorated neurologically over the next 24 hours and was euthanased on humane grounds. The horse was submitted for necropsy. Gross pathology was unremarkable except for a small amount of haemorrhage around the right kidney. Histopathology revealed no abnormalities in any muscle groups or peripheral nerves. Congestion and axonal swelling of the spinal cord was evident from T16 to S1. Ischaemic neurons were evident from L 1 to L 6. The most prominent lesions were at L4 and L5. A diagnosis of myelomalacia was made. This is a rare complication of anaesthesia in horses with 9 case studies appearing in the literature since 1979. This is the 1st case to be reported in South Africa. The speculated pathophysiology and risk factors for this complication are discussed.

  3. Evaluation of genotoxicity induced by repetitive administration of local anaesthetics: an experimental study in rats

    Directory of Open Access Journals (Sweden)

    Gisele Alborghetti Nai

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVE: Previous studies regarding the effects of some local anaesthetics have suggested that these agents can cause genetic damage. However, they have not been tested for genotoxicity related to repetitive administration. The aim of this study was to evaluate the genotoxic potential of local anaesthetics upon repetitive administration. METHODS: 80 male Wistar rats were divided into: group A - 16 rats intraperitoneally injected with lidocaine hydrochloride 2%; group B - 16 rats IP injected with mepivacaine 2%; group C - 16 rats intraperitoneally injected with articaine 4%; group D - 16 rats IP injected with prilocaine 3% (6.0 mg/kg; group E - 8 rats subcutaneously injected with a single dose of cyclophosphamide; and group F - 8 rats intraperitoneally injected with saline. Eight rats from groups A to D received a single dose of anaesthetic on Day 1 of the experiment; the remaining rats were dosed once a day for 5 days. RESULTS: The median number of micronuclei in the local anaesthetics groups exposed for 1 or 5 days ranged from 0.00 to 1.00, in the cyclophosphamide-exposed group was 10.00, and the negative control group for 1 and 5 days was 1.00 and 0.00, respectively (p 0.05. CONCLUSION: No genotoxicity effect was observed upon repetitive exposure to any of the local anaesthetics evaluated.

  4. Caffeine in the neonatal period induces long-lasting changes in sleep and breathing in adult rats.

    Science.gov (United States)

    Montandon, Gaspard; Horner, Richard L; Kinkead, Richard; Bairam, Aida

    2009-11-15

    Caffeine is commonly used clinically to treat apnoeas and unstable breathing associated with premature birth. Caffeine antagonizes adenosine receptors and acts as an efficient respiratory stimulant in neonates. Owing to its persistent effects on adenosine receptor expression in the brain, neonatal caffeine administration also has significant effects on maturation of the respiratory control system. However, since adenosine receptors are critically involved in sleep regulation, and sleep also modulates breathing, we tested the hypothesis that neonatal caffeine treatment disrupts regulation of sleep and breathing in the adult rat. Neonatal caffeine treatment (15 mg kg(-1) day(-1)) was administered from postnatal days 3-12. At adulthood (8-10 weeks old), sleep and breathing were measured with a telemetry system and whole-body plethysmography respectively. In adult rats treated with caffeine during the neonatal period, sleep time was reduced, sleep onset latency was increased, and non-rapid eye movement (non-REM) sleep was fragmented compared to controls. Ventilation at rest was higher in caffeine-treated adult rats compared to controls across sleep/wake states. Hypercapnic ventilatory responses were significantly reduced in caffeine-treated rats compared to control rats across sleep/wake states. Additional experiments in adult anaesthetized rats showed that at similar levels of arterial blood gases, phrenic nerve activity was enhanced in caffeine-treated rats. This study demonstrates that administration of caffeine in the neonatal period alters respiratory control system activity in awake and sleeping rats, as well as in the anaesthetized rats, and also has persistent disrupting effects on sleep that are apparent in adult rats.

  5. Standardization of exhaled breath condensate (EBC) collection using a feedback regulated breathing pattern

    Science.gov (United States)

    Collection of exhaled breath condensate (EBC) fluid by cooling of expired breath is a potentially valuable approach for the detection of biomarkers associated with disease or exposure to xenobiotics. EBC is generally collected using unregulated breathing patterns, perceived to el...

  6. A lack of anaesthetic clinical attachments for emergency medicine advanced trainees in New Zealand: perceptions of directors of emergency medicine training.

    Science.gov (United States)

    Browne, Alexander

    2015-08-07

    Anaesthetic skills are a core competency for emergency physicians. Anecdotally, there are limited anaesthetic attachments specifically available for Emergency Medicine Advanced Trainees (ATs). This study had several aims: Firstly, to quantify anaesthetic terms set aside for ATs; secondly, to gauge the opinions of Directors of Emergency Medicine Training (DEMTs) regarding the importance and difficulty in securing and maintaining anaesthetic training terms for ATs in their institutions; thirdly, to outline strategies that DEMTs used to get or maintain these posts and their opinions about what institutions should do to provide anaesthetic training for ATs. An online qualitative survey was emailed to all DEMTs of hospitals accredited for vocational ED training within New Zealand. Registered Medical Officer (RMO) units at accredited hospitals were asked to provide numbers of anaesthetic places available specifically for ATs. Annually there are 15 anaesthetic training posts set aside for 145 ATs. Most DEMTs thought that an anaesthetic term was important for progression of vocational training, and a majority thought that term availability was a significant barrier to progression of training. A number of DEMTs felt that procuring and maintaining anaesthetic posts was difficult, some citing a lack of collegiality from anaesthetic departments. Some DEMTs and ATs used novel approaches to procure anaesthetic attachments. Anaesthetic skills are an essential component of emergency medicine vocational training. It is in the best interests of hospitals to provide anaesthetic training positions for ATs. There are few training positions currently available.

  7. Anaesthetic considerations in children with congenital heart disease undergoing non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Jagdish Menghraj Shahani

    2012-01-01

    Full Text Available The objective of this article is to provide an updated and comprehensive review on current perioperative anaesthetic management of paediatric patients with congenital heart disease (CHD coming for non-cardiac surgery. Search of terms such as "anaesthetic management," "congenital heart disease" and "non-cardiac surgery" was carried out in KKH eLibrary, PubMed, Medline and Google, focussing on significant current randomised control trials, case reports, review articles and editorials. Issues on how to tailor perioperative anaesthetic management on cases with left to right shunt, right to left shunt and complex heart disease are discussed in this article. Furthermore, the author also highlights special considerations such as pulmonary hypertension, neonates with CHD coming for extracardiac surgery and the role of regional anaesthesia in children with CHD undergoing non-cardiac operation.

  8. Assessment of anaesthetic depth by clustering analysis and autoregressive modelling of electroencephalograms

    DEFF Research Database (Denmark)

    Thomsen, C E; Rosenfalck, A; Nørregaard Christensen, K

    1991-01-01

    The brain activity electroencephalogram (EEG) was recorded from 30 healthy women scheduled for hysterectomy. The patients were anaesthetized with isoflurane, halothane or etomidate/fentanyl. A multiparametric method was used for extraction of amplitude and frequency information from the EEG....... The method applied autoregressive modelling of the signal, segmented in 2 s fixed intervals. The features from the EEG segments were used for learning and for classification. The learning process was unsupervised and hierarchical clustering analysis was used to construct a learning set of EEG amplitude......-frequency patterns for each of the three anaesthetic drugs. These EEG patterns were assigned to a colour code corresponding to similar clinical states. A common learning set could be used for all patients anaesthetized with the same drug. The classification process could be performed on-line and the results were...

  9. Anaesthetic considerations for patients undergoing pre-surgical embolization of intracranial and spinal tumours: An overview

    Directory of Open Access Journals (Sweden)

    Suparna Bharadwaj

    2015-01-01

    Full Text Available Pre-surgical embolization of vascular brain and spinal tumours is an effective method of reducing intraoperative bleeding. Many technological developments of the microcatheters and embolic materials that are used have led to better outcomes in tumour embolization. Pre-operative embolization has become a standard of practice in the management of many vascular brain and spinal tumours. Anaesthesiologists are generally involved with these procedures which may be performed with general anaesthesia, conscious sedation or monitored anaesthesia care. The choice of the anaesthetic technique usually depends on the patient characteristics, tumour location, vascularity of the tumour and most importantly the neuroradiologist and/or institutional preferences. There is limited information in the literature on the anaesthetic considerations for these patients. The aim of this review is to provide a brief overview of the indications, techniques, complications and relevant anaesthetic considerations for patients undergoing pre-surgical embolization of intracranial and spinal tumours.

  10. The effect of dexmedetomidine on cerebral perfusion and oxygenation in healthy piglets with normal and lowered blood pressure anaesthetized with propofol-remifentanil total intravenous anaesthesia

    DEFF Research Database (Denmark)

    Mikkelsen, Mai Louise Grandsgaard; Ambrus, Rikard; Rasmussen, Rune

    2017-01-01

    Background During anaesthesia and surgery, in particular neurosurgery, preservation of cerebral perfusion and oxygenation (CPO) is essential for normal postoperative brain function. The isolated effects on CPO of either individual anaesthetic drugs or entire anaesthetic protocols are of importance...

  11. Slow Breathing and Hypoxic Challenge: Cardiorespiratory Consequences and Their Central Neural Substrates

    Science.gov (United States)

    Critchley, Hugo D.; Nicotra, Alessia; Chiesa, Patrizia A.; Nagai, Yoko; Gray, Marcus A.; Minati, Ludovico; Bernardi, Luciano

    2015-01-01

    Controlled slow breathing (at 6/min, a rate frequently adopted during yoga practice) can benefit cardiovascular function, including responses to hypoxia. We tested the neural substrates of cardiorespiratory control in humans during volitional controlled breathing and hypoxic challenge using functional magnetic resonance imaging (fMRI). Twenty healthy volunteers were scanned during paced (slow and normal rate) breathing and during spontaneous breathing of normoxic and hypoxic (13% inspired O2) air. Cardiovascular and respiratory measures were acquired concurrently, including beat-to-beat blood pressure from a subset of participants (N = 7). Slow breathing was associated with increased tidal ventilatory volume. Induced hypoxia raised heart rate and suppressed heart rate variability. Within the brain, slow breathing activated dorsal pons, periaqueductal grey matter, cerebellum, hypothalamus, thalamus and lateral and anterior insular cortices. Blocks of hypoxia activated mid pons, bilateral amygdalae, anterior insular and occipitotemporal cortices. Interaction between slow breathing and hypoxia was expressed in ventral striatal and frontal polar activity. Across conditions, within brainstem, dorsal medullary and pontine activity correlated with tidal volume and inversely with heart rate. Activity in rostroventral medulla correlated with beat-to-beat blood pressure and heart rate variability. Widespread insula and striatal activity tracked decreases in heart rate, while subregions of insular cortex correlated with momentary increases in tidal volume. Our findings define slow breathing effects on central and cardiovascular responses to hypoxic challenge. They highlight the recruitment of discrete brainstem nuclei to cardiorespiratory control, and the engagement of corticostriatal circuitry in support of physiological responses that accompany breathing regulation during hypoxic challenge. PMID:25973923

  12. Post anaesthetic myopathy/neuropathy in horses undergoing magnetic resonance imaging compared to horses undergoing surgery.

    Science.gov (United States)

    Franci, P; Leece, E A; Brearley, J C

    2006-11-01

    Patient positioning and long anaesthetic duration required for magnetic resonance imaging (MRI) may result in a higher frequency of post anaesthetic myopathy/neuropathy syndrome (PAMNS) as compared to horses undergoing anaesthesia for surgery. Equine anaesthesia for MRI is associated with a higher frequency of PAMNS than anaesthesia for nonemergency, nonabdominal surgery. Anaesthetic and medical records of horses (n = 633) undergoing MRI or surgery between January 2001 and January 2005 (inclusive), were reviewed. Information obtained included patient details (breed, sex, age, bodyweight), area of body scanned or involved in surgery, body position, anaesthetic and inotropic agents administered, anaesthetic duration, adverse events during anaesthesia and outcome at 7 days. Data were examined by cross tabulation and Chi-square or Fisher's exact test of association. The influence of individual variables was examined by univariant and multivariant analysis models. There were no statistically significant differences between the 2 groups in parameters examined, except that horses in the MRI group were heavier (Phorses (2.3%, 95% Confidence interval [CI]: 1.1-4.2) in the MRI group had clinical signs of PAMNS in the post anaesthetic period, whereas only 2 horses (0.98%, 95% CI: 0.2-2.8) in the surgery group were affected. This was not statistically significantly different (odds ratio = 2.7, 95% CI: 0.8-13, P = 0.3). Two horses undergoing MRI were subjected to euthanasia due to the severity of PAMNS. There was no difference in the occurrence of PAMNS between the 2 groups. The risk of performing general anaesthesia for diagnostic procedures such as MRI may not be greater than that for a surgical procedure. However, the benefits should be carefully weighed against the risks involved.

  13. Method development for the enantiomeric purity determination of low concentrations of adrenaline in local anaesthetic solutions by capillary electrophoresis

    NARCIS (Netherlands)

    Sänger-Van De Griend, Cari E.; Ek, Anders G.; Widahl-Näsman, Monica E.; Andersson, E. K Margareta

    2006-01-01

    L-Adrenaline is often included in local anaesthetic (LA) solutions for injection to improve the quality of the anaesthetic block. The concentration of the LA is between 2.5 and 20 mg/ml and the concentration of adrenaline is typically ≤0.1% of the LA concentration. In order to follow the

  14. Preparation of the Drager Fabius CE and Drager Zeus anaesthetic machines for patients susceptible to malignant hyperthermia.

    LENUS (Irish Health Repository)

    Shanahan, Hiliary

    2012-05-01

    Malignant hyperthermia may follow exposure to trace quantities of inhalational anaesthetics. In susceptible patients, the complete avoidance of these triggers is advised when possible; however, failing this, it is essential to washout or purge the anaesthesia machine of residual inhalational anaesthetics.

  15. Local anaesthetic toxicity in a pregnant patient undergoing lignocaine-induced intravenous regional anaesthesia.

    LENUS (Irish Health Repository)

    Coleman, M

    2012-02-03

    A pregnant patient at 38 weeks\\' gestation developed symptoms of local anaesthetic toxicity following intravenous regional anaesthesia (IVRA) for hand surgery, using a standard dose of lignocaine. Reports suggest that a number of factors, both physiological and pharmacological, combine to increase the likelihood of local anaesthetic (LA) toxicity in pregnancy despite employment of a conventional "safe" IVRA technique. It is suggested that for IVRA, pregnant patients are premedicated with a benzodiazepine, the tourniquet time is increased and the concentration of LA is decreased to reduce the risks of LA toxicity.

  16. Analgesic efficacy of local anaesthetic wound administration in knee arthroplasty: volume vs concentration

    DEFF Research Database (Denmark)

    Andersen, L Ø; Gaarn-Larsen, L; Kristensen, B B

    2010-01-01

    Wound administration of local anaesthetic may be effective for postoperative pain management in knee arthroplasty, but the analgesic efficacy of local anaesthetic in relation to volume vs concentration has not been determined. In a double-blinded trial, 48 patients scheduled for total knee...... arthroplasty were randomly assigned to receive either a high volume/low concentration solution of ropivacaine (20 ml, 0.5%) or a low volume/high concentration solution of ropivacaine (10 ml, 1%), 6 and 24 h postoperatively through an intracapsular catheter. Pain was assessed for 2 h after administration. Pain...... was reduced in both groups with ropivacaine administration 24 h postoperatively (p

  17. The cerebral cost of breathing: an FMRI case-study in congenital central hypoventilation syndrome.

    Directory of Open Access Journals (Sweden)

    Mike Sharman

    Full Text Available Certain motor activities--like walking or breathing--present the interesting property of proceeding either automatically or under voluntary control. In the case of breathing, brainstem structures located in the medulla are in charge of the automatic mode, whereas cortico-subcortical brain networks--including various frontal lobe areas--subtend the voluntary mode. We speculated that the involvement of cortical activity during voluntary breathing could impact both on the "resting state" pattern of cortical-subcortical connectivity, and on the recruitment of executive functions mediated by the frontal lobe. In order to test this prediction we explored a patient suffering from central congenital hypoventilation syndrome (CCHS, a very rare developmental condition secondary to brainstem dysfunction. Typically, CCHS patients demonstrate efficient cortically-controlled breathing while awake, but require mechanically-assisted ventilation during sleep to overcome the inability of brainstem structures to mediate automatic breathing. We used simultaneous EEG-fMRI recordings to compare patterns of brain activity between these two types of ventilation during wakefulness. As compared with spontaneous breathing (SB, mechanical ventilation (MV restored the default mode network (DMN associated with self-consciousness, mind-wandering, creativity and introspection in healthy subjects. SB on the other hand resulted in a specific increase of functional connectivity between brainstem and frontal lobe. Behaviorally, the patient was more efficient in cognitive tasks requiring executive control during MV than during SB, in agreement with her subjective reports in everyday life. Taken together our results provide insight into the cognitive and neural costs of spontaneous breathing in one CCHS patient, and suggest that MV during waking periods may free up frontal lobe resources, and make them available for cognitive recruitment. More generally, this study reveals how the

  18. Breathing adapted radiotherapy for breast cancer: comparison of free breathing gating with the breath-hold technique

    DEFF Research Database (Denmark)

    Korreman, Stine Sofia; Pedersen, Anders N; Nøttrup, Trine Jakobi

    2005-01-01

    BACKGROUND AND PURPOSE: Adjuvant radiotherapy after breast-conserving surgery for breast cancer implies a risk of late cardiac and pulmonary toxicity. This is the first study to evaluate cardiopulmonary dose sparing of breathing adapted radiotherapy (BART) using free breathing gating......, and to compare this respiratory technique with voluntary breath-hold. PATIENTS AND METHODS: 17 patients were CT-scanned during non-coached breathing manoeuvre including free breathing (FB), end-inspiration gating (IG), end-expiration gating (EG), deep inspiration breath-hold (DIBH) and end-expiration breath......-hold (EBH). The Varian Real-time Position Management system (RPM) was used to monitor respiratory movement and to gate the scanner. For each breathing phase, a population based internal margin (IM) was estimated based on average chest wall excursion, and incorporated into an individually optimised three...

  19. Blue breath holding is benign.

    Science.gov (United States)

    Stephenson, J B

    1991-01-01

    In their recent publication in this journal, Southall et al described typical cyanotic breath holding spells, both in otherwise healthy children and in those with brainstem lesions and other malformations. Their suggestions regarding possible autonomic disturbances may require further study, but they have adduced no scientific evidence to contradict the accepted view that in the intact child blue breath holding spells are benign. Those families in which an infant suffers an 'apparently life threatening event' deserve immense understanding and help, and it behoves investigators to exercise extreme care and self criticism in the presentation of new knowledge which may bear upon their management and their morale. PMID:2001115

  20. Early abnormalities of post-sigh breathing in a mouse model of Rett syndrome.

    Science.gov (United States)

    Voituron, N; Zanella, S; Menuet, C; Lajard, A M; Dutschmann, M; Hilaire, G

    2010-02-28

    Rett syndrome is a neurodevelopmental disease accompanied by complex, disabling symptoms, including breathing symptoms. Because Rett syndrome is caused by mutations in the transcriptional repressor methyl-CpG-binding protein 2 (MeCP2), Mecp2-deficient mice have been generated as experimental model. Males of Mecp2-deficient mice (Mecp2(-/y)) breathe normally at birth but show abnormal respiratory responses to hypoxia and hypercapnia from postnatal day 25 (P25). After P30, Mecp2(-/y) mice develop breathing symptoms reminiscent of Rett syndrome, aggravating until premature death at around P60. Using plethysmography, we analyzed the sighs and the post-sigh breathing pattern of unrestrained wild type male mice (WT) and Mecp2(-/y) mice from P15 to P60. Sighs are spontaneous large inspirations known to prevent lung atelectasis and to improve alveolar oxygenation. However, Mecp2(-/y) mice show early abnormalities of post-sigh breathing, with long-lasting post-sigh apnoeas, reduced tidal volume when eupnoea resumes and lack of post-sigh bradypnoea which develop from P15, aggravate with age and possibly contribute to breathing symptoms to come. Copyright 2010 Elsevier B.V. All rights reserved.

  1. Spontaneous Atraumatic Mediastinal Hemorrhage

    Directory of Open Access Journals (Sweden)

    Morkos Iskander BSc, BMBS, MRCS, PGCertMedEd

    2013-04-01

    Full Text Available Spontaneous atraumatic mediastinal hematomas are rare. We present a case of a previously fit and well middle-aged lady who presented with acute breathlessness and an increasing neck swelling and spontaneous neck bruising. On plain chest radiograph, widening of the mediastinum was noted. The bruising was later confirmed to be secondary to mediastinal hematoma. This life-threatening diagnostic conundrum was managed conservatively with a multidisciplinary team approach involving upper gastrointestinal and thoracic surgeons, gastroenterologists, radiologists, intensivists, and hematologists along with a variety of diagnostic modalities. A review of literature is also presented to help surgeons manage such challenging and complicated cases.

  2. Oral breathing and speech disorders in children

    Directory of Open Access Journals (Sweden)

    Silvia F. Hitos

    2013-07-01

    Conclusion: Mouth breathing can affect speech development, socialization, and school performance. Early detection of mouth breathing is essential to prevent and minimize its negative effects on the overall development of individuals.

  3. Volatile sulphur compounds in morning breath of human volunteers

    NARCIS (Netherlands)

    Snel, Johannes; Burgering, Maurits; Smit, Bart; Noordman, Wouter; Tangerman, Albert; Winkel, Edwin G.; Kleerebezem, Michiel

    Objective: Morning breath contains elevated concentrations of volatile sulphur components (VSCs). Therefore, morning breath is recognised as a surrogate target for interventions on breath quality. Nevertheless, factors influencing morning breath are poorly understood. Our aim was to evaluate

  4. Volatile sulphur compounds in morning breath of human volunteers.

    NARCIS (Netherlands)

    Snel, J.; Burgering, M.; Smit, B.; Noordman, W.; Tangerman, A.; Winkel, E.G.; Kleerebezem, M.

    2011-01-01

    OBJECTIVE: morning breath contains elevated concentrations of volatile sulphur components (VSCs). Therefore, morning breath is recognised as a surrogate target for interventions on breath quality. Nevertheless, factors influencing morning breath are poorly understood. Our aim was to evaluate

  5. The effect of inert gas choice on multiple breath washout in healthy infants: differences in lung function outcomes and breathing pattern.

    Science.gov (United States)

    Gustafsson, Per M; Bengtsson, Lovisa; Lindblad, Anders; Robinson, Paul D

    2017-12-01

    The detrimental effects on breathing pattern during multiple breath inert gas washout (MBW) have been described with different inhaled gases [100% oxygen (O 2 ) and sulfur hexafluoride (SF 6 )] but detailed comparisons are lacking. N 2 - and SF 6 -based tests were performed during spontaneous quiet sleep in 10 healthy infants aged 0.7-1.3 yr using identical hardware. Differences in breathing pattern pre and post 100% O 2 and 4% SF 6 exposure were investigated, and the results obtained were compared [functional residual capacity (FRC) and lung clearance index (LCI)]. During 100% O 2 exposure. mean inspiratory flow ("respiratory drive") decreased transiently by mean (SD) 28 (9)% ( P pattern of change reversed. No significant effect on breathing pattern was observed during SF 6 testing. In vitro testing confirmed that technical artifacts did not explain these changes. Mean (SD) FRC and LCI in vivo were significantly higher with N 2 vs. SF 6 washout: 216 (33) vs. 186 (22) ml ( P pattern during test performance and the functional residual capacity and lung clearance index values obtained. Data suggest the detrimental effect of breathing pattern of 100% O 2 and movement of O 2 across the alveolar capillary membrane, with direct effects on MBW outcomes. SF 6 MBW during infancy avoids this and can be further optimized by addressing the sources of technical artifact identified in this work.

  6. 14CO2 in breath

    International Nuclear Information System (INIS)

    Rabinowitz, J.L.; Lopez-Majano, V.

    1981-01-01

    The diagnosis of metabolic disorders can be made by detecting 14 CO 2 in the breath. This is possible because 14 CO 2 can label any organic compound without any deteriorations in the nature of the compound. This type of analysis is dependable, noninvasive and simple to perform with a scintillation counter. (orig.)

  7. Submarines, Spacecraft, and Exhaled Breath

    Science.gov (United States)

    The International Association of Breath Research (IABR) meetings are an eclectic gathering of researchers in the medical, environmental and instrumentation fields; our focus is on human health as assessed by the measurement and interpretation of trace chemicals in human exhaled b...

  8. Breathing retraining: a rational placebo?

    NARCIS (Netherlands)

    Garssen, B.; de Ruiter, C.; van Dyck, R.

    1992-01-01

    Breathing retraining of patients with Hyperventilation Syndrome (HVS) and/or panic disorder is discussed to evaluate its clinical effectiveness and to examine the mechanism that mediates its effect. In relation to this theoretical question, the validity of HVS as a scientific model is discussed and

  9. Anaesthetic management of a patient with hereditary angioedema

    Directory of Open Access Journals (Sweden)

    Nergis Ataol

    2015-12-01

    Full Text Available Hereditary angioedema is a rare autosomal dominant disorder caused by reduced activity of the C1 esterase inhibitor. Patients with hereditary angioedema are clinically characterized by recurrent episodes of swelling of the extremities, face, trunk, airways and abdominal organs. Attacks may occur either spontaneously or following trauma, stress, surgery, infections and hormonal fluctuations. The most common cause of death is asphyxia related to laryngeal edema. Giving C1 esterase inhibitor is the most effective method of treatment. Also fresh frozen plasma, androgen steroids, quinine pathway inhibitors, antifibrinolytics and bradykinin receptor antagonists can be used as treatment. In this paper, the anesthetic management of a patient with hereditary angioedema undergoing inguinal hernia repair surgery is reported.

  10. Cyclohexanol analogues are positive modulators of GABAA receptor currents and act as general anaesthetics in vivo

    Science.gov (United States)

    GABAA receptors meet all the pharmacological criteria required to be considered important general anaesthetic targets. In the following study, the modulatory effects of various commercially available and novel cyclohexanol were investigated on recombinant human '-aminobutyric acid (GABAA, a1ß2'2s) r...

  11. Monitoring variables affecting positron emission tomography measurements of cerebral blood flow in anaesthetized pigs

    DEFF Research Database (Denmark)

    Alstrup, Aage Kristian Olsen; Zois, Nora Elisabeth; Simonsen, Mette

    2018-01-01

    Background Positron emission tomography (PET) imaging of anaesthetized pig brains is a useful tool in neuroscience. Stable cerebral blood flow (CBF) is essential for PET, since variations can affect the distribution of several radiotracers. However, the effect of physiological factors regulating...

  12. Anaesthetic implications of laparoscopic splenectomy in patients with sickle cell anaemia.

    LENUS (Irish Health Repository)

    Doodnath, R

    2012-02-01

    With the increasing immigrant population in the Republic of Ireland, the number of patients with sickle cell disease (SCD) seen in the paediatric hospitals is climbing. In this case report, we review the anaesthetic implications and outcome of the first two paediatric patients with SCD to have a laparoscopic splenectomy due to repeated splenic infarcts in the Republic of Ireland.

  13. Anaesthetic implications of laparoscopic splenectomy in patients with sickle cell anaemia.

    LENUS (Irish Health Repository)

    Doodnath, R.

    2010-04-01

    With the increasing immigrant population in the Republic of Ireland, the number of patients with sickle cell disease (SCD) seen in the paediatric hospitals is climbing. In this case report, we review the anaesthetic implications and outcome of the first two paediatric patients with SCD to have a laparoscopic splenectomy due to repeated splenic infarcts in the Republic of Ireland.

  14. Quantitative EEG in assessment of anaesthetic depth: comparative study of methodology

    DEFF Research Database (Denmark)

    Thomsen, C. E.; Prior, P. F.

    1996-01-01

    features. We have compared the performance of four techniques using tape-recorded data from 23 patients anaesthetized with either halothane or isoflurane using standardized regimens. The techniques were: (1) median frequency, (2) spectral edge frequency, (3) the cerebral function analysing monitor (CFAM1...

  15. Local anaesthetics modifying the dermal response of irradiation. An experimental study

    Energy Technology Data Exchange (ETDEWEB)

    Ohlsen, L.; Evers, H.; Segerstroem, K.; Hagelqvist, E.; Graffman, S.

    1987-01-01

    In a series of experiments in rabbits the dermal reaction, provoked by a single dose or intermittent doses of irradiation, was prevented or modified by topical or parenteral administration of local anaesthetics, compared to irradiated control animals. The topical application of a eutectic lidocaine/prilocaine cream, EMLA 5%, was found to be more effective than intravenously injected lidocaine (Xylocain 1%).

  16. Pharmacokinetics and pharmacodynamics of eltanolone (pregnanolone), a new steroid intravenous anaesthetic, in humans

    DEFF Research Database (Denmark)

    Carl, Peder; Høgskilde, S; Lang-Jensen, T

    1994-01-01

    Eltanolone, a new intravenous steroid anaesthetic agent was administered intravenously in a dose of 0.6 mg.kg-1 over 45 s to eight healthy male volunteers to evaluate some of its pharmacokinetic and pharmacodynamic effects. Drug concentration-time data were analysed by PCNONLIN, a non-linear regr...

  17. Anaesthetic safety of the Macintosh® oral laryngeal spray device

    African Journals Online (AJOL)

    2013-01-14

    Jan 14, 2013 ... Regular checks of the remaining Macintosh® atomiser apparatus have been instituted. Inflammation of the oral mucosa may increase the absorption of local anaesthetic. Markedly elevated plasma lignocaine levels have been described in an adult with oral candidiasis after receiving topical lignocaine.5 ...

  18. [The profitability of various methods of desinfection for anaesthetic equipment (author's transl)].

    Science.gov (United States)

    Herbst, H

    1975-06-01

    This is a presentation of the three most utilized methods of desinfection - steam, acethylenoxide aldehyde solution - for anaesthetic equipment as to their costs. During series of tests the wear and tear has been checked. The desinfection by aldehyde solution is worth the price as to the investigation, the current costs and the wear and tear.

  19. A Parturient with Chronic Immune Thrombocytopenic Purpura: Anaesthetic Management for Caesarean Section

    Directory of Open Access Journals (Sweden)

    Sushma KS

    2015-08-01

    Full Text Available Immune Thrombocytopenic Purpura (ITP accounts for 4-5% of cases of pregnancy with thrombocytopenia. Their clinical condition may deteriorate during pregnancy subjecting these patients at high risk of bleeding. We report anaesthetic management of a parturient with chronic ITP for caesarean section.

  20. Comparative efficacy of four anaesthetic agents in the yellow seahorse, Hippocampus kuda (Bleeker, 1852)

    Digital Repository Service at National Institute of Oceanography (India)

    Pawar, H.B.; Sanaye, S.V.; Sreepada, R.A.; Harish, V.; Suryavanshi, U.; Tanu; Ansari, Z.A.

    -bred yellow seahorse, Hippocampus kuda (Bleeker, 1852). The lowest effective concentrations based on the efficacy criteria of complete anaesthetic induction within 180 s and recovery within 300 s were determined to be 125 mg L sup(-1) (induction 115 + or - 16...

  1. Effects of chronic occupational exposure to anaesthetic gases on the rate of neutrophil apoptosis among anaesthetists.

    LENUS (Irish Health Repository)

    Tyther, R

    2012-02-03

    BACKGROUND AND OBJECTIVE: Volatile anaesthetic agents are known to influence neutrophil function. The aim was to determine the effect of chronic occupational exposure to volatile anaesthetic agents on the rate of neutrophil apoptosis among anaesthetists. To test this hypothesis, we compared the rate of neutrophil apoptosis in anaesthetists who had been chronically exposed to volatile anaesthetic agents with that in unexposed volunteers. METHODS: Venous blood (20 mL) was withdrawn from 24 ASA I-II volunteers, from which neutrophils were isolated, and maintained in culture. At 1, 12 and 24 h in culture, the percentage of neutrophil apoptosis was assessed by dual staining with annexin V-FITC and propidium iodide. RESULTS: At 1 h (but not at 12 and 24 h) in culture, the rate of neutrophil apoptosis was significantly less in the anaesthetists--13.8 (12.9%) versus 34.4 (12.1%) (P = 0.001). CONCLUSIONS: Chronic occupational exposure to volatile anaesthetic agents may inhibit neutrophil apoptosis. This may have implications for anaesthetists and similarly exposed healthcare workers in terms of the adequacy of their inflammatory response.

  2. Functional Analysis and Intervention for Breath Holding.

    Science.gov (United States)

    Kern, Lee; And Others

    1995-01-01

    A functional analysis of breath-holding episodes in a 7-year-old girl with severe mental retardation and Cornelia-de-Lange syndrome indicated that breath holding served an operant function, primarily to gain access to attention. Use of extinction, scheduled attention, and a picture card communication system decreased breath holding. (Author/SW)

  3. 21 CFR 868.5620 - Breathing mouthpiece.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Breathing mouthpiece. 868.5620 Section 868.5620...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5620 Breathing mouthpiece. (a) Identification. A breathing mouthpiece is a rigid device that is inserted into a patient's mouth and that...

  4. Relationships between breath ratios, spirituality and health ...

    African Journals Online (AJOL)

    The aim of this retrospective, quantitative study was to investigate relationships between breath ratios, spirituality perceptions and health perceptions, with special reference to breath ratios that best predict optimal health and spirituality. Significant negative correlations were found between breath ratios and spirituality ...

  5. Breath psychotherapy | Edwards | Inkanyiso: Journal of Humanities ...

    African Journals Online (AJOL)

    Breath psychotherapy is an approach that makes direct use of the breath in healing. There are many forms of breathbased healing: basic breathing and relaxation methods, with or without the practice of psychological skills such as imagery, centring and concentration; expressive physical and emotional techniques; ...

  6. Omega-3 fatty acids protect fatty and lean mouse livers after major hepatectomy

    OpenAIRE

    Linecker, Michael; Limani, Perparim; Kambakamba, Patryk; Kron, Philipp; Tschuor, Christoph; Calo, Nicolas; Foti, Michelangelo; Dufour, Jean-François; Graf, Rolf; Humar, Bostjan; Clavien, Pierre-Alain

    2017-01-01

    Objective: To evaluate the regional distribution of ventilation in horses during spontaneous breathing and controlled mechanical ventilation (CMV) using electrical impedance tomography (EIT). Study design: Prospective, experimental case series. Animals: Four anaesthetized experimental horses. Methods: Horses were anaesthetized with isoflurane in an oxygen-air mixture and medetomidine continuous rate infusion, placed in dorsal recumbency with an EIT belt around the thorax, and allowed...

  7. Spontaneous Appendicocutaneous Fistula I

    African Journals Online (AJOL)

    M T0k0de* MB, BS and. Dr 0. A. AWOj0bi+ FMCS (Nig). ABSTRACT. Ruptured appendicitis is not a common cause of spontaneous enterocutaneous fistula. A case of ruptured retrocaecal appendicitis presenting as an enterocutaneous fistula in a Nigerian woman is presented. The literature on this disorder is also reviewed.

  8. [Spontaneous bacterial peritonitis].

    Science.gov (United States)

    Strauss, Edna; Caly, Wanda Regina

    2003-01-01

    Spontaneous bacterial peritonitis occurs in 30% of patients with ascites due to cirrhosis leading to high morbidity and mortality rates. The pathogenesis of spontaneous bacterial peritonitis is related to altered host defenses observed in end-stage liver disease, overgrowth of microorganisms, and bacterial translocation from the intestinal lumen to mesenteric lymph nodes. Clinical manifestations vary from severe to slight or absent, demanding analysis of the ascitic fluid. The diagnosis is confirmed by a number of neutrophils over 250/mm3 associated or not to bacterial growth in culture of an ascites sample. Enterobacteriae prevail and Escherichia coli has been the most frequent bacterium reported. Mortality rates decreased markedly in the last two decades due to early diagnosis and prompt antibiotic treatment. Third generation intravenous cephalosporins are effective in 70% to 95% of the cases. Recurrence of spontaneous bacterial peritonitis is common and can be prevented by the continuous use of oral norfloxacin. The development of bacterial resistance demands the search for new options in the prophylaxis of spontaneous bacterial peritonitis; probiotics are a promising new approach, but deserve further evaluation. Short-term antibiotic prophylaxis is recommended for patients with cirrhosis and ascites shortly after an acute episode of gastrointestinal bleeding.

  9. Spontaneous Grammar Explanations.

    Science.gov (United States)

    Tjoo, Hong Sing; Lewis, Marilyn

    1998-01-01

    Describes one New Zealand university language teacher's reflection on her own grammar explanations to university-level students of Bahasa Indonesian. Examines form-focused instruction through the teacher's spontaneous answers to students' questions about the form of the language they are studying. The teacher's experiences show that it takes time…

  10. EDITORIAL SPONTANEOUS BACTERIAL PERITONITIS ...

    African Journals Online (AJOL)

    hi-tech

    Spontaneous bacterial peritonitis (SBP) frequent]y occurs in patients with liver cirrhosis and ascites. It is defined as an infection of previously sterile ascitic fluid without any demonstrable intrabdominal source of infection. It is now internationally agreed that a polymorphonuclear (PMN) cell count in the ascitic fluid of over 250 ...

  11. Spontaneous dimensional reduction?

    Science.gov (United States)

    Carlip, Steven

    2012-10-01

    Over the past few years, evidence has begun to accumulate suggesting that spacetime may undergo a "spontaneous dimensional reduction" to two dimensions near the Planck scale. I review some of this evidence, and discuss the (still very speculative) proposal that the underlying mechanism may be related to short-distance focusing of light rays by quantum fluctuations.

  12. Prepubertal gonadectomy in cats: different injectable anaesthetic combinations and comparison with gonadectomy at traditional age.

    Science.gov (United States)

    Porters, Nathalie; de Rooster, Hilde; Moons, Christel P H; Duchateau, Luc; Goethals, Klara; Bosmans, Tim; Polis, Ingeborgh

    2015-06-01

    Anaesthetic and analgesic effects of three different injectable anaesthetic combinations for prepubertal gonadectomy (PPG) in cats were studied. One anaesthetic protocol was compared with a similar one for gonadectomy at traditional age (TAG). Kittens were randomly assigned to PPG or TAG. For PPG, three different protocols were compared: (1) intramuscular (IM) administration of 60 μg/kg dexmedetomidine plus 20 μg/kg buprenorphine followed by an IM injection of the anaesthetic agent (20 mg/kg ketamine) (DB-IM protocol); (2) oral transmucosal (OTM) administration of 80 μg/kg dexmedetomidine plus 20 μg/kg buprenorphine followed by an IM injection of 20 mg/kg ketamine combined with 20 µg/kg dexmedetomidine (DB-OTM protocol); (3) IM injection of a 40 μg/kg medetomidine-20 μg/kg buprenorphine-20 mg/kg ketamine combination (MBK-IM protocol). For TAG, a DB-IM protocol was used, but with different doses for dexmedetomidine (40 μg/kg) and ketamine (5 mg/kg). All cats (PPG and TAG) received a non-steroidal anti-inflammatory before surgery. Anaesthetic and analgesic effects were assessed pre- and postoperatively (until 6 h). Cumulative logit, linear and logistic regression models were used for statistical analysis. Compared with the DB-OTM protocol, the DB-IM and MBK-IM protocols provided better anaesthesia with fewer adverse effects in PPG cats. Postoperative pain was not significantly different between anaesthetic protocols. PPG and TAG cats anaesthetised with the two DB-IM protocols differed significantly only for sedation and pain scores, but sedation and pain scores were generally low. Although there were no anaesthesia-related mortalities in the present study and all anaesthetic protocols for PPG in cats provided a surgical plane of anaesthesia and analgesia up to 6 h postoperatively, our findings were in favour of the intramuscular (DB-IM and MBK-IM) protocols. © ISFM and AAFP 2014.

  13. Changes in Mice Brain Spontaneous Electrical Activity during Cortical Spreading Depression due to Mobile Phone Radiation.

    Science.gov (United States)

    Sallam, Samera M; Mohamed, Ehab I; Dawood, Abdel-Fattah B

    2008-06-01

    The objective of the present study was to investigate changes in spontaneous EEG activity during cortical spreading depression (CSD) in mice brain. The cortical region of anaesthetized mice were exposed to the electromagnetic fields (EMFs) emitted from a mobile phone (MP, 935.2-960.2 MHz, 41.8 mW/cm(2)). The effect of EMFs on EEG was investigated before and after exposure to different stimuli (MP, 2% KCl, and MP & 2% KCl). The records of brain spontaneous EEG activity, slow potential changes (SPC), and spindle shaped firings were obtained through an interfaced computer. The results showed increases in the amplitude of evoked spindles by about 87%, 17%, and 226% for MP, 2% KCl, and MP & 2% KCl; respectively, as compared to values for the control group. These results showed that the evoked spindle is a more sensitive indicator of the effect of exposure to EMFs from MP.

  14. Does the supplementary motor area keep patients with Ondine's curse syndrome breathing while awake?

    Directory of Open Access Journals (Sweden)

    Lysandre Tremoureux

    Full Text Available BACKGROUND: Congenital central hypoventilation syndrome (CCHS is a rare neuro-respiratory disorder associated with mutations of the PHOX2B gene. Patients with this disease experience severe hypoventilation during sleep and are consequently ventilator-dependent. However, they breathe almost normally while awake, indicating the existence of cortical mechanisms compensating for the deficient brainstem generation of automatic breathing. Current evidence indicates that the supplementary motor area plays an important role in modulating ventilation in awake normal humans. We hypothesized that the wake-related maintenance of spontaneous breathing in patients with CCHS could involve supplementary motor area. METHODS: We studied 7 CCHS patients (5 women; age: 20-30; BMI: 22.1 ± 4 kg.m(-2 during resting breathing and during exposure to carbon dioxide and inspiratory mechanical constraints. They were compared with 8 healthy individuals. Segments of electroencephalographic tracings were selected according to ventilatory flow signal, from 2.5 seconds to 1.5 seconds after the onset of inspiration. After artefact rejection, 80 or more such segments were ensemble averaged. A slow upward shift of the EEG signal starting between 2 and 0.5 s before inspiration (pre-inspiratory potential was considered suggestive of supplementary motor area activation. RESULTS: In the control group, pre-inspiratory potentials were generally absent during resting breathing and carbon dioxide stimulation, and consistently identified in the presence of inspiratory constraints (expected. In CCHS patients, pre-inspiratory potentials were systematically identified in all study conditions, including resting breathing. They were therefore significantly more frequent than in controls. CONCLUSIONS: This study provides a neurophysiological substrate to the wakefulness drive to breathe that is characteristic of CCHS and suggests that the supplementary motor area contributes to this phenomenon

  15. Does the supplementary motor area keep patients with Ondine's curse syndrome breathing while awake?

    Science.gov (United States)

    Tremoureux, Lysandre; Raux, Mathieu; Hudson, Anna L; Ranohavimparany, Anja; Straus, Christian; Similowski, Thomas

    2014-01-01

    Congenital central hypoventilation syndrome (CCHS) is a rare neuro-respiratory disorder associated with mutations of the PHOX2B gene. Patients with this disease experience severe hypoventilation during sleep and are consequently ventilator-dependent. However, they breathe almost normally while awake, indicating the existence of cortical mechanisms compensating for the deficient brainstem generation of automatic breathing. Current evidence indicates that the supplementary motor area plays an important role in modulating ventilation in awake normal humans. We hypothesized that the wake-related maintenance of spontaneous breathing in patients with CCHS could involve supplementary motor area. We studied 7 CCHS patients (5 women; age: 20-30; BMI: 22.1 ± 4 kg.m(-2)) during resting breathing and during exposure to carbon dioxide and inspiratory mechanical constraints. They were compared with 8 healthy individuals. Segments of electroencephalographic tracings were selected according to ventilatory flow signal, from 2.5 seconds to 1.5 seconds after the onset of inspiration. After artefact rejection, 80 or more such segments were ensemble averaged. A slow upward shift of the EEG signal starting between 2 and 0.5 s before inspiration (pre-inspiratory potential) was considered suggestive of supplementary motor area activation. In the control group, pre-inspiratory potentials were generally absent during resting breathing and carbon dioxide stimulation, and consistently identified in the presence of inspiratory constraints (expected). In CCHS patients, pre-inspiratory potentials were systematically identified in all study conditions, including resting breathing. They were therefore significantly more frequent than in controls. This study provides a neurophysiological substrate to the wakefulness drive to breathe that is characteristic of CCHS and suggests that the supplementary motor area contributes to this phenomenon. Whether or not this "cortical breathing" can be taken

  16. ANAESTHETIC CHALLENGES IN THE MANAGEMENT OF PEDIATRIC ENCEPHALOCOELE REPAIR: RETROSPECTIVE CASE SERIES

    Directory of Open Access Journals (Sweden)

    Ravindra Giri

    2015-02-01

    Full Text Available INTRODUCTION: Encephalocele is the protrusion of the cranial contents beyond the normal confines of the skull through a defect in the calvarium and is far less common than spinal dysraphism. 1 Anaesthetic challenges in management of occipital meningoencephalocele include securing the airway with intubation in lateral position, intraoperative prone position and its associated complications, careful securing of the endotracheal tube and accurate assessment of blood loss. These babies also have associated congenital anomalie s, gastrointestinal malrotation, renal anomalies, cardiac malformations and tracheoesophageal fistula, making anaesthetic management even more difficult. Meticulous anaesthetic management is crucial for early repair of encephalocoele to prevent any sequel. 2 METHODS: To identify the anaesthetic challenges, perioperative and postoperative complications during encephalocele repair, 20 cases were studied retrospectively from 2012 to 2014 at Department of Anaesthesia , Department of Neurosurgery, MR Medical College, Gulbarga. RESULTS: 20 cases of encephalocoele repair were undertaken during the study period. Out of these 12 (60% were male and 8(40% female. Age range was 1 day to 6 years. Most common type of encephalocele was occipital 12(60%, which posed a difficulty during positioning & intubation, followed by occipito - cervical 4(20%, Parietal 2(10%, Fronto - nasal 1(5% & Fronto - naso - ethmoidal 1(5%. Most of the patients were extubated successfully on table, only one patient required post - operative ventilator support for a day. Peri - operative complications included bronchospasm (15%, followed by hypotension, tachycardia, laryngospasm, hypoxia, accidental extubation (10% each & bradycardia, endobronchial intubation (5%. CONCLUSION: Children with Encephalocoele are prone to have peri - operative complications which can be managed by meticulous anaesthetic managenement. 3 Early surgical management of encephalocoele is not

  17. Clarifying the role of activated charcoal filters in preparing an anaesthetic workstation for malignant hyperthermia-susceptible patients.

    Science.gov (United States)

    Bilmen, J G; Gillies, R I

    2014-01-01

    Malignant hyperthermia (MH) is a life-threatening condition caused by exposure of susceptible individuals to volatile anaesthetics or suxamethonium. MH-susceptible individuals must avoid exposure to these drugs, so accurate and reproducible processes to remove residual anaesthetic agents from anaesthetic workstations are required. Activated charcoal filters (ACFs) have been used for this purpose. ACFs can reduce the time for preparing an anaesthetic workstation for MH patients. Currently, the only commercially available ACFs are the Vapor-Clean$trade; (Dynasthetics, Salt Lake City, UT, USA) filters which retail at approximately AUD$130 per set of two, both of which are to be used in a single anaesthetic. Anaesthetic workstations were saturated with anaesthetic vapours and connected to a Miran ambient air analyser (SapphRe XL, ThermoScientific, Waltham, MA, USA) to measure vapour concentration. Various scenarios were tested in order to determine the most economical configurations of machine flushing, component change and activated charcoal filter use. We found that placement of filters in an unprepared, saturated circuit was insufficient to safely prepare an anaesthetic workstation. Following flushing of the anaesthetic workstation with high-flow oxygen for 90 seconds, a circuit and soda lime canister change and the placement of an ACF on the inspiratory limb, we were able to safely prepare a workstation in less than three minutes. A single filter on the inspiratory limb was able to maintain a clean circuit for 12 hours, with gas flows dropped from 10 lpm to 3 lpm after 90 minutes or removal of the filter after 90 minutes if high gas flows were maintained.

  18. An observational study of patient care outcomes sensitive to handover quality in the Post-Anaesthetic Care Unit.

    Science.gov (United States)

    Lillibridge, Nichole; Botti, Mari; Wood, Beverley; Redley, Bernice

    2017-12-01

    To identify patient care outcome indicators sensitive to the quality of interprofessional handover between the anaesthetist and the Post-Anaesthetic Care Unit nurse. The relationship between interprofessional clinical handover when patients are transferred from the operating theatre to the Post-Anaesthetic Care Unit and patient outcomes of subsequent patient care delivery is not well understood. Naturalistic, exploratory descriptive design using observation. Observations of 31 patient journeys through Post-Anaesthetic Care Units across three public and private hospitals. Characteristics of interprofessional handover on arrival in the Post-Anaesthetic Care Unit, the trajectory of patient care activities in Post-Anaesthetic Care Unit and patient outcomes were observed. Of the 821 care activities observed across 31 "patient journeys" in the Post-Anaesthetic Care Unit, observations (assessments and vital signs) (52.5 %), communication (15.8 %) and pain management (assessment of pain and analgesic administration) (10.3%) were most common. Examination of patterns in handover communications and subsequent trajectories of patient care activities revealed three patient trajectory typologies and two patient outcome indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit: pain on discharge from the Post-Anaesthetic Care Unit and timely response to clinical deterioration. An additional process indicator, seeking missing information, was also identified. Patient's pain on discharge from Post-Anaesthetic Care Unit, escalation of care in response to early signs of deterioration and the need for nurses to seek out missing information to deliver care are indicators expected to be sensitive to the quality of interprofessional handover communication in the Post-Anaesthetic Care Unit. Future research should test these indicators. Patient outcomes sensitive to the quality of interprofessional handover on patient

  19. Analysis of Exhaled Breath for Disease Detection

    Science.gov (United States)

    Amann, Anton; Miekisch, Wolfram; Schubert, Jochen; Buszewski, Bogusław; Ligor, Tomasz; Jezierski, Tadeusz; Pleil, Joachim; Risby, Terence

    2014-06-01

    Breath analysis is a young field of research with great clinical potential. As a result of this interest, researchers have developed new analytical techniques that permit real-time analysis of exhaled breath with breath-to-breath resolution in addition to the conventional central laboratory methods using gas chromatography-mass spectrometry. Breath tests are based on endogenously produced volatiles, metabolites of ingested precursors, metabolites produced by bacteria in the gut or the airways, or volatiles appearing after environmental exposure. The composition of exhaled breath may contain valuable information for patients presenting with asthma, renal and liver diseases, lung cancer, chronic obstructive pulmonary disease, inflammatory lung disease, or metabolic disorders. In addition, oxidative stress status may be monitored via volatile products of lipid peroxidation. Measurement of enzyme activity provides phenotypic information important in personalized medicine, whereas breath measurements provide insight into perturbations of the human exposome and can be interpreted as preclinical signals of adverse outcome pathways.

  20. Spontaneous healing of spontaneous coronary artery dissection.

    Science.gov (United States)

    Almafragi, Amar; Convens, Carl; Heuvel, Paul Van Den

    2010-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome and sudden cardiac death. It should be suspected in every healthy young woman without cardiac risk factors, especially during the peripartum or postpartum periods. It is important to check for a history of drug abuse, collagen vascular disease or blunt trauma of the chest. Coronary angiography is essential for diagnosis and early management. We wonder whether thrombolysis might aggravate coronary dissection. All types of treatment (medical therapy, percutaneous intervention or surgery) improve the prognosis without affecting survival times if used appropriately according to the clinical stability and the angiographic features of the involved coronary arteries. Prompt recognition and targeted treatment improve outcomes. We report a case of SCAD in a young female free of traditional cardiovascular risk factors, who presented six hours after thrombolysis for ST elevation myocardial infarction. Coronary angiography showed a dissection of the left anterior descending and immediate branch. She had successful coronary artery bypass grafting, with complete healing of left anterior descending dissection.

  1. Spontaneous spinal epidural abscess.

    LENUS (Irish Health Repository)

    Ellanti, P

    2011-10-01

    Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.

  2. [Stahl, Leibniz, Hoffmann and breathing].

    Science.gov (United States)

    Carvallo, Sarah

    2006-01-01

    At the beginning of the XVIII th century, Wilhelm Gottfried Leibniz and Friedrich Hoffmann criticize Georg Ernst Stahl's medical theory. They differenciate between unsound and true reasonings. Namely, they validate Stahl's definition of breath but extracting it from its animist basis and placing it in an epistemology obeying to the principle of sufficient reason and to the mechanical model. The stahlian discovery consists in understanding breath as a calorific ventilation against the ancient conception; the iatromechanists recognize its accuracy, but they try then to transpose it to a mechanical model of ventilation. Using it in a different epistemological context implies that they analyze the idea of discovery "true" in its contents, but "wrong" in its hypothesis. It impels to examine the epistemology of medical knowledge, as science and therapeutics, and in its links with the other scientific theories. Thus, if Leibniz as philosopher and Hoffmann as doctor consider Stahl's animism so important, it is because its discoveries question the fundamental principles of medicine.

  3. TR-BREATH: Time-Reversal Breathing Rate Estimation and Detection.

    Science.gov (United States)

    Chen, Chen; Han, Yi; Chen, Yan; Lai, Hung-Quoc; Zhang, Feng; Wang, Beibei; Liu, K J Ray

    2018-03-01

    In this paper, we introduce TR-BREATH, a time-reversal (TR)-based contact-free breathing monitoring system. It is capable of breathing detection and multiperson breathing rate estimation within a short period of time using off-the-shelf WiFi devices. The proposed system exploits the channel state information (CSI) to capture the miniature variations in the environment caused by breathing. To magnify the CSI variations, TR-BREATH projects CSIs into the TR resonating strength (TRRS) feature space and analyzes the TRRS by the Root-MUSIC and affinity propagation algorithms. Extensive experiment results indoor demonstrate a perfect detection rate of breathing. With only 10 s of measurement, a mean accuracy of can be obtained for single-person breathing rate estimation under the non-line-of-sight (NLOS) scenario. Furthermore, it achieves a mean accuracy of in breathing rate estimation for a dozen people under the line-of-sight scenario and a mean accuracy of in breathing rate estimation of nine people under the NLOS scenario, both with 63 s of measurement. Moreover, TR-BREATH can estimate the number of people with an error around 1. We also demonstrate that TR-BREATH is robust against packet loss and motions. With the prevailing of WiFi, TR-BREATH can be applied for in-home and real-time breathing monitoring.

  4. Comparing charcoal and zeolite reflection filters for volatile anaesthetics: A laboratory evaluation.

    Science.gov (United States)

    Sturesson, Louise W; Frennström, Jan O; Ilardi, Marcella; Reinstrup, Peter

    2015-08-01

    A modified heat-moisture exchanger that incorporates a reflecting filter for use with partial rebreathing of exhaled volatile anaesthetics has been commercially available since the 1990 s. The main advantages of the device are efficient delivery of inhaled sedation to intensive care patients and reduced anaesthetic consumption during anaesthesia. However, elevated arterial CO2 values have been observed with an anaesthetic conserving device compared with a conventional heat and moisture exchanger, despite compensation for larger apparatus dead space. The objective of this study is to thoroughly explore the properties of two reflecting materials (charcoal and zeolites). A controlled, prospective, observational laboratory study. Lund University Hospital, Sweden, from December 2011 to December 2012. None. Three filters, with identical volumes, were compared using different volatile anaesthetics at different conditions of temperature and moisture. The filtering materials were charcoal or zeolite. Glass spheres were used as an inert control. Consumption of volatile anaesthetics using different reflecting materials in filters at different conditions regarding temperature and moisture. CO2 reflection by the filtering materials: glass spheres, charcoal or zeolite. Isoflurane consumption in an open system was 60.8 g h(-1). The isoflurane consumption in dry, warm air was 39.8 g h(-1) with glass spheres. Changing to charcoal and zeolite had a profound effect on isoflurane consumption, 11.8 and 10.7 g h(-1), respectively. Heating and humidifying the air as well as the addition of N2O created only minor changes in consumption. The percentage of isoflurane conserved by the charcoal filter was independent of the isoflurane concentration (0.5 to 4.5%). Reflection of sevoflurane, desflurane and halothane by the charcoal filter was similar to reflection of isoflurane. Both charcoal and zeolite filters had CO2 reflecting properties and end-tidal CO2 increased by 3 to 3.7% compared

  5. Thoracic radiotherapy and breath control: current prospects

    International Nuclear Information System (INIS)

    Reboul, F.; Mineur, L.; Paoli, J.B.; Bodez, V.; Oozeer, R.; Garcia, R.

    2002-01-01

    Three-dimensional conformal radiotherapy (3D CRT) is adversely affected by setup error and organ motion. In thoracic 3D CRT, breathing accounts for most of intra-fraction movements, thus impairing treatment quality. Breath control clearly exhibits dosimetric improvement compared to free breathing, leading to various techniques for gated treatments. We review benefits of different breath control methods -i.e. breath-holding or beam gating, with spirometric, isometric or X-ray respiration sensor- and argument the choice of expiration versus inspiration, with consideration to dosimetric concerns. All steps of 3D-CRT can be improved with breath control. Contouring of organs at risk (OAR) and target are easier and more accurate on breath controlled CT-scans. Inter- and intra-fraction target immobilisation allows smaller margins with better coverage. Lung outcome predictors (NTCP, Mean Dose, LV20, LV30) are improved with breath-control. In addition, inspiration breath control facilitates beam arrangement since it widens the distance between OAR and target, and leaves less lung normal tissue within the high dose region. Last, lung density, as of CT scan, is more accurate, improving dosimetry. Our institutions choice is to use spirometry driven, patient controlled high-inspiration breath-hold; this technique gives excellent immobilization results, with high reproducibility, yet it is easy to implement and costs little extra treatment time. Breath control, whatever technique is employed, proves superior to free breathing treatment when using 3D-CRT. Breath control should then be used whenever possible, and is probably mandatory for IMRT. (authors)

  6. Change of central hemodynamics of qualified athletes for testing the use of controlled breathing and evaluation

    Directory of Open Access Journals (Sweden)

    A.P. Romanchuk

    2013-11-01

    Full Text Available Using spiroarteriocardiorhythmography surveyed 174 qualified athletes (121 male and 53 female. The examination consisted of three consecutive two-minute registrations - spontaneous, controlled breathing 6 and 15 breaths per minute. Found that the hemodynamic change substantially when the respiratory tests in the first place, cardiac output, cardiac index, total peripheral vascular resistance and specific peripheral vascular resistance. To develop criteria for evaluation of hemodynamic changes carried percentile variance analysis of all indicators in the performance tests. Testing of the evaluation criteria for different types of hemodynamics in athletes allowed to establish that eukinetic type characteristic is the reduction in heart rate and pulse blood pressure under test with controlled breathing 6 times per minute for hypokinetic – pronounced increase in systolic blood pressure and pulse blood pressure during the breath tests 6 and 15 times per minute for hyperkinetic – reducing end-diastolic volume, end-systolic volume, stroke volume, in vivo performance of both tests and an increase in systemic vascular resistance during test 15 breaths per minute.

  7. Masticatory Changes in Oral Breath Secondary to Allergic Rhinitis: Integrative Review

    Directory of Open Access Journals (Sweden)

    Bezerra, Luciana Ângelo

    2014-04-01

    Full Text Available Introduction The III Brazilian Consensus on Rhinitis (2012 defines allergic rhinitis as a nasal mucosa inflammation, mediated by immunoglobulin E, after exposure to allergens. The classic signs and symptoms of allergic rhinitis are nasal obstruction, watery rhinorrhea, sneezing, and nasal itching, often reversible either spontaneously or with treatment, and mouth breathing (breathing predominantly through the mouth, regardless of the cause, due to a nasal breathing impairment in some cases. Objective To evaluate the literature on masticatory changes in children with mouth breathing due to allergic rhinitis. Methods We conducted a search of the past 10 years, at Bireme and MEDLINE databases, for articles that covered masticatory changes in children with mouth breathing secondary to allergic rhinitis. Results We found 1,986 articles, including 15 repeated in databases, but only two articles met the inclusion criteria fully. Discussion We found few studies to answer the question raised in this review, and those studies have some methodological limitations. Most articles claimed no have statistically significant differences in masticatory changes in this population. Conclusion A better controlled study (isolating diseases, exposure time, with a larger sample (sample calculation appropriate, would be necessary to examine such changes.

  8. Kidney motion during free breathing and breath hold for MR-guided radiotherapy

    Science.gov (United States)

    Stam, Mette K.; van Vulpen, Marco; Barendrecht, Maurits M.; Zonnenberg, Bernard A.; Intven, Martijn; Crijns, Sjoerd P. M.; Lagendijk, Jan J. W.; Raaymakers, Bas W.

    2013-04-01

    Current treatments for renal cell carcinoma have a high complication rate due to the invasiveness of the treatment. With the MRI-linac it may be possible to treat renal tumours non-invasively with high-precision radiotherapy. This is expected to reduce complications. To deliver a static dose distribution, radiation gating will be used. In this study the reproducibility and efficiency of free breathing gating and a breath hold treatment of the kidney was investigated. For 15 patients with a renal lesion the kidney motion during 2 min of free breathing and 10 consecutive expiration breath holds was studied with 2D cine MRI. The variability in kidney expiration position and treatment efficiency for gating windows of 1 to 20 mm was measured for both breathing patterns. Additionally the time trend in free breathing and the variation in expiration breath hold kidney position with baseline shift correction was determined. In 80% of the patients the variation in expiration position during free breathing is smaller than 2 mm. No clinically relevant time trends were detected. The variation in expiration breath hold is for all patients larger than the free breathing expiration variation. Gating on free breathing is, for gating windows of 1 to 5 mm more efficient than breath hold without baseline correction. When applying a baseline correction to the breath hold it increases the treatment efficiency. The kidney position is more reproducible in expiration free breathing than non-guided expiration breath hold. For small gating windows it is also more time efficient. Since free breathing also seems more comfortable for the patients it is the preferred breathing pattern for MRI-Linac treatments of the kidney.

  9. Kidney motion during free breathing and breath hold for MR-guided radiotherapy

    International Nuclear Information System (INIS)

    Stam, Mette K; Van Vulpen, Marco; Intven, Martijn; Crijns, Sjoerd P M; Lagendijk, Jan J W; Raaymakers, Bas W; Barendrecht, Maurits M; Zonnenberg, Bernard A

    2013-01-01

    Current treatments for renal cell carcinoma have a high complication rate due to the invasiveness of the treatment. With the MRI-linac it may be possible to treat renal tumours non-invasively with high-precision radiotherapy. This is expected to reduce complications. To deliver a static dose distribution, radiation gating will be used. In this study the reproducibility and efficiency of free breathing gating and a breath hold treatment of the kidney was investigated. For 15 patients with a renal lesion the kidney motion during 2 min of free breathing and 10 consecutive expiration breath holds was studied with 2D cine MRI. The variability in kidney expiration position and treatment efficiency for gating windows of 1 to 20 mm was measured for both breathing patterns. Additionally the time trend in free breathing and the variation in expiration breath hold kidney position with baseline shift correction was determined. In 80% of the patients the variation in expiration position during free breathing is smaller than 2 mm. No clinically relevant time trends were detected. The variation in expiration breath hold is for all patients larger than the free breathing expiration variation. Gating on free breathing is, for gating windows of 1 to 5 mm more efficient than breath hold without baseline correction. When applying a baseline correction to the breath hold it increases the treatment efficiency. The kidney position is more reproducible in expiration free breathing than non-guided expiration breath hold. For small gating windows it is also more time efficient. Since free breathing also seems more comfortable for the patients it is the preferred breathing pattern for MRI-Linac treatments of the kidney. (paper)

  10. Anaesthetic management of a patient with microvillus inclusion disease for intestinal transplantation.

    Science.gov (United States)

    Goldman, Luis J; Santamaría, Manuel López; Gámez, Manuel

    2002-03-01

    We report the anaesthetic management of a 3-year-old-child with microvillus inclusion disease undergoing isolated small bowel transplantation. He required long-term total parenteral nutrition which was complicated with numerous episodes of catheter related sepsis. This resulted in thrombosis of the major blood vessels which critically restricted vascular access available for intravenous nutrition, becoming a life-threatening condition for the patient. Haemodynamic, respiratory parameters and urinary output were well preserved throughout the procedure. Besides a transitory increase in potassium following graft revascularization, biochemical changes were small. Anaesthetic management included comprehensive preoperative assessment, central venous angiography to depict accessibility of central and peripheral veins, assurance of additional vascular access through the intraoperative catheterization of the left renal vein, perioperative epidural analgesia and preservation of splanchnic perfusion to ensure implant viability.

  11. Anaesthetic Management of Caesarean Section in a Patient with Large Mediastinal Mass

    International Nuclear Information System (INIS)

    Kashif, S.; Saleem, J.

    2015-01-01

    Pregnancy is associated with both anatomical and physiological changes in the body, especially in cardiovascular and respiratory systems. Patients with anterior and middle mediastinal masses are recognized to be at risk for cardiorespiratory compromise. Likewise, pregnancy has a widely known constellation of potential complications that confront the anaesthesiologist. The combination of both (pregnancy and mediastinal mass) in a single patient presents an unusual anaesthetic challenge. Caesarean sections are usually the mode of delivery, therefore, the cardio-respiratory stability is very important. The following is the report of a 31 weeks pregnant patient with a large, symptomatic anterior and middle mediastinal mass, who required anaesthesia for emergency caesarean section. The anaesthetic management entailed Combined Spinal and Epidural (CSE) technique with safe feto-maternal outcome. (author)

  12. Emergency Surgery in a Patient with Scleroderma - Anaesthetic Challenges: A Case Report

    Directory of Open Access Journals (Sweden)

    Teena Bansal Sarla Hooda

    2013-06-01

    Full Text Available Scleroderma (progressive systemic sclerosis is a multisystem disease involving the skin, airway, musculoskeletal, gastrointestinal, pulmonary, renal and cardiac systems that can pose a significant challenge for the anaesthetist. The multisystem involvement of scleroderma can impact on every aspect of anaesthetic care especially airway management. There are no specific contraindications to the use of any type of anaesthesia, although the selection must be guided by identification of organ dysfunction. The anaesthetist must be aware of the organs involved, the severity of the disease and the associated anaesthetic considerations and potential risks in order to safely & skilfully manage the patient with scleroderma. We hereby present a case report of a patient with scleroderma for emergency orbital decompression because of orbital cellulitis.

  13. Anaesthetic management of patients with congenital heart disease presenting for non-cardiac surgery.

    Directory of Open Access Journals (Sweden)

    Mohindra R

    2002-01-01

    Full Text Available The incidence of congenital heart disease is about one percent of all live births in the United States. Treatment is being performed at a younger age and these children are showing improved survival. It is not unusual for children with congenital heart disease to present for non-cardiac surgery. Their management depends on their age, type of lesion, extent of corrective procedure, the presence of complications and other congenital anomalies. Each patient needs a detailed pre-operative evaluation to understand the abnormal anatomy and physiology, and related anaesthetic implications. No anaesthetic agent is an absolute contraindication, although drugs beneficial for one lesion may be detrimental for another. Regional anaesthesia has also been safely used in children with congenital heart disease. However the anaesthesiologist must have a detailed understanding of the pathophysiology of the lesion and the pharmacology of drugs being used to be able to provide safe anaesthesia for children with congenital heart disease.

  14. Robot Assisted Renal Auto Transplantation: A Case Based Discussion of Unique Anaesthetic Considerations

    Directory of Open Access Journals (Sweden)

    Praveen Gupta

    2015-02-01

    Full Text Available Laparoscopic renal autotransplantation has serious perturbations on the body's homeostasis due to its non physiological positioning, use of pneumoperitoneum, changing fluid strategy at different points of time and on-going steps to maintain optimal environment for the transplanted kidney. Generally speaking, the anaesthetic management of renal auto-transplantation by open technique is not very complex and the perioperative management can be categorized in the intermediate level of clinical skill requirement. Adding to the comfort of the anaesthesiologist is the fact that these patients are not in end stage renal disease state and does not manifest the comorbidities, multisystem involvement and technical complexities of long term renal dysfunction and renal replacement therapy. In our case report surgeons used the da Vinci surgical robotic system for laparoscopic transplantation of the kidney at a new site. In this article we discuss the anaesthetic challenges of robot assisted laparoscopic renal auto-transplantation along with a description of our index case.

  15. Horses Auto-Recruit Their Lungs by Inspiratory Breath Holding Following Recovery from General Anaesthesia.

    Directory of Open Access Journals (Sweden)

    Martina Mosing

    Full Text Available This study evaluated the breathing pattern and distribution of ventilation in horses prior to and following recovery from general anaesthesia using electrical impedance tomography (EIT. Six horses were anaesthetised for 6 hours in dorsal recumbency. Arterial blood gas and EIT measurements were performed 24 hours before (baseline and 1, 2, 3, 4, 5 and 6 hours after horses stood following anaesthesia. At each time point 4 representative spontaneous breaths were analysed. The percentage of the total breath length during which impedance remained greater than 50% of the maximum inspiratory impedance change (breath holding, the fraction of total tidal ventilation within each of four stacked regions of interest (ROI (distribution of ventilation and the filling time and inflation period of seven ROI evenly distributed over the dorso-ventral height of the lungs were calculated. Mixed effects multi-linear regression and linear regression were used and significance was set at p<0.05. All horses demonstrated inspiratory breath holding until 5 hours after standing. No change from baseline was seen for the distribution of ventilation during inspiration. Filling time and inflation period were more rapid and shorter in ventral and slower and longer in most dorsal ROI compared to baseline, respectively. In a mixed effects multi-linear regression, breath holding was significantly correlated with PaCO2 in both the univariate and multivariate regression. Following recovery from anaesthesia, horses showed inspiratory breath holding during which gas redistributed from ventral into dorsal regions of the lungs. This suggests auto-recruitment of lung tissue which would have been dependent and likely atelectic during anaesthesia.

  16. Efficacy and tolerability of yoga breathing in patients with chronic obstructive pulmonary disease: a pilot study.

    Science.gov (United States)

    Pomidori, Luca; Campigotto, Federica; Amatya, Tara Man; Bernardi, Luciano; Cogo, Annalisa

    2009-01-01

    Yoga-derived breathing has been reported to improve gas exchange in patients with chronic heart failure and in participants exposed to high-altitude hypoxia. We investigated the tolerability and effect of yoga breathing on ventilatory pattern and oxygenation in patients with chronic obstructive pulmonary disease (COPD). Patients with COPD (N = 11, 3 women) without previous yoga practice and taking only short-acting beta2-adrenergic blocking drugs were enrolled. Ventilatory pattern and oxygen saturation were monitored by means of inductive plethysmography during 30-minute spontaneous breathing at rest (sb) and during a 30-minute yoga lesson (y). During the yoga lesson, the patients were requested to mobilize in sequence the diaphragm, lower chest, and upper chest adopting a slower and deeper breathing. We evaluated oxygen saturation (SaO2%), tidal volume (VT), minute ventilation (E), respiratory rate (i>f), inspiratory time, total breath time, fractional inspiratory time, an index of thoracoabdominal coordination, and an index of rapid shallow breathing. Changes in dyspnea during the yoga lesson were assessed with the Borg scale. During the yoga lesson, data showed the adoption of a deeper and slower breathing pattern (VTsb L 0.54[0.04], VTy L 0.74[0.08], P = .01; i>fsb 20.8[1.3], i>fy 13.8[0.2], P = .001) and a significant improvement in SaO2% with no change in E (SaO2%sb 91.5%[1.13], SaO2%y 93.5%[0.99], P = .02; Esb L/min 11.2[1.1], Ey L/min 10.2[0.9]). All the participants reported to be comfortable during the yoga lesson, with no increase in dyspnea index. We conclude that short-term training in yoga is well tolerated and induces favorable respiratory changes in patients with COPD.

  17. Relationships between hippocampal activity and breathing patterns

    DEFF Research Database (Denmark)

    Harper, R M; Poe, G R; Rector, D M

    1998-01-01

    Single cell discharge, EEG activity, and optical changes accompanying alterations in breathing patterns, as well as the knowledge that respiratory musculature is heavily involved in movement and other behavioral acts, implicate hippocampal regions in some aspects of breathing control. The control...... is unlikely to reside in oscillatory breathing movements, because such patterns emerge in preparations retaining only the medulla (and perhaps only the spinal cord). However, momentary changes in breathing patterns induced by affect, startle, whole-body movement changes, or compensatory ventilatory changes...... of hippocampal contributions to breathing control should be viewed in the context that significant interactions exist between blood pressure changes and ventilation, and that modest breathing challenges, such as exposure to hypercapnia or to increased resistive loads, bring into action a vast array of brain...

  18. Volatile anaesthetics enhance the metastasis related cellular signalling including CXCR2 of ovarian cancer cells.

    Science.gov (United States)

    Iwasaki, Masae; Zhao, Hailin; Jaffer, Tanweer; Unwith, Sandeep; Benzonana, Laura; Lian, Qingquan; Sakamoto, Atsuhiro; Ma, Daqing

    2016-05-03

    The majority of ovarian cancer patients relapse after surgical resection. Evidence is accumulating regarding the role of surgery in disseminating cancer cells; in particular anaesthesia may have an impact on cancer re-occurrence. Here, we have investigated the metastatic potential of volatile anaesthetics isoflurane, sevoflurane and desflurane on ovarian cancer cells. Human ovarian carcinoma cells (SKOV3) were exposed to isoflurane (2%), sevoflurane (3.6%) or desflurane (10.3%) for 2 hours. Metastatic related gene expression profiles were measured using the Tumour Metastasis PCR Array and qRT-PCR. Subsequently vascular endothelial growth factor A (VEGF-A), matrix metalloproteinase 11 (MMP11), transforming growth factor beta-1 (TGF-β1) and chemokine (C-X-C motif) receptor 2 (CXCR2) proteins expression were determined using immunofluorescent staining. The migratory capacities of SK-OV3 cells were assessed with a scratch assay and the potential role of CXCR2 in mediating the effects of volatile anaesthetics on cancer cell biology were further investigated with CXCR2 knockdown by siRNA. All three volatile anaesthetics altered expression of 70 out of 81 metastasic related genes with significant increases in VEGF-A, MMP-11, CXCR2 and TGF-β genes and protein expression with a magnitude order of desflurane (greatest), sevoflurane and isoflurane. Scratch analysis revealed that exposure to these anesthetics increased migration, which was abolished by CXCR2 knockdown. Volatile anaesthetics at clinically relevant concentrations have strong effects on cancer cell biology which in turn could enhance ovarian cancer metastatic potential. This work raises the urgency for further in vivo studies and clinical trials before any conclusions can be made in term of the alteration of clinical practice.

  19. Perioperative Anaesthetic Management of Caesarean Delivery in a Parturient with Portal Gastropathy

    Directory of Open Access Journals (Sweden)

    Ashwini H Ramaswamy

    2014-12-01

    Full Text Available Portal hypertensive gastropathy occurs both in cirrhotic and non cirrhotic patients leading to haemetemesis secondary to oesophageal varices. The hyper dynamic circulatory state of pregnancy in these patients poses special problems necessitating specialized care preferably in a tertiary care centre. We report the perioperative anaesthetic management for elective caesarean section in a 32-year-old pregnant lady at 39 weeks gestation with portal gastropathy secondary to periportal fibrosis of the liver.

  20. Usefulness of an injectable anaesthetic protocol for semen collection through urethral catheterisation in domestic cats.

    Science.gov (United States)

    Pisu, Maria Carmela; Ponzio, Patrizia; Rovella, Chiara; Baravalle, Michela; Veronesi, Maria Cristina

    2017-10-01

    Objectives Although less often requested in comparison with dogs, the collection of semen in cats can be necessary for artificial insemination, for semen evaluation in tom cats used for breeding and for semen storage. Urethral catheterisation after pharmacological induction with medetomidine has proved to be useful for the collection of semen in domestic cats. However, most of the previously used protocols require the administration of high doses of medetomidine that can increase the risk of side effects, especially on the cardiovascular system. In routine clinical practice, one safe and useful injectable anaesthetic protocol for short-term clinical investigations or surgery in cats involves premedication with low intramuscular doses of dexmedetomidine with methadone, followed by intravenous propofol bolus injection. We aimed to assess the usefulness of this injectable anaesthetic protocol for semen collection, via urethral catheterisation, in domestic cats. Methods The study was performed on 38 purebred, adult cats, during the breeding season, and semen was collected via urethral catheterisation using an injectable anaesthesia protocol with methadone (0.2 mg/kg) and dexmedetomidine (5 µg/kg) premedication, followed by induction with propofol. Results The anaesthetic protocol used in the present study allowed the collection of large-volume semen samples, characterised by good parameters and without side effects. Conclusions and relevance The results from the present study suggest that the injectable anaesthetic protocol using methadone and dexmedetomidine premedication, followed by induction with propofol, could be suitable and safe for the collection of a good-quality semen sample, via urethral catheterisation, in domestic cats. It can therefore be used as an alternative to previous medetomidine-based sedation protocols.

  1. Spontaneous Thigh Compartment Syndrome

    Directory of Open Access Journals (Sweden)

    Khan, Sameer K

    2011-02-01

    Full Text Available A young man presented with a painful and swollen thigh, without any history of trauma, illness, coagulopathic medication or recent exertional exercise. Preliminary imaging delineated a haematoma in the anterior thigh, without any fractures or muscle trauma. Emergent fasciotomies were performed. No pathology could be identified intra-operatively, or on follow-up imaging. A review of thigh compartment syndromes described in literature is presented in a table. Emergency physicians and traumatologists should be cognisant of spontaneous atraumatic presentations of thigh compartment syndrome, to ensure prompt referral and definitive management of this limb-threatening condition. [West J Emerg Med. 2011;12(1:134-138].

  2. Nucleosome breathing and remodeling constrain CRISPR-Cas9 function.

    Science.gov (United States)

    Isaac, R Stefan; Jiang, Fuguo; Doudna, Jennifer A; Lim, Wendell A; Narlikar, Geeta J; Almeida, Ricardo

    2016-04-28

    The CRISPR-Cas9 bacterial surveillance system has become a versatile tool for genome editing and gene regulation in eukaryotic cells, yet how CRISPR-Cas9 contends with the barriers presented by eukaryotic chromatin is poorly understood. Here we investigate how the smallest unit of chromatin, a nucleosome, constrains the activity of the CRISPR-Cas9 system. We find that nucleosomes assembled on native DNA sequences are permissive to Cas9 action. However, the accessibility of nucleosomal DNA to Cas9 is variable over several orders of magnitude depending on dynamic properties of the DNA sequence and the distance of the PAM site from the nucleosome dyad. We further find that chromatin remodeling enzymes stimulate Cas9 activity on nucleosomal templates. Our findings imply that the spontaneous breathing of nucleosomal DNA together with the action of chromatin remodelers allow Cas9 to effectively act on chromatin in vivo.

  3. Meigs′ syndrome in an elderly woman with short of breath

    Directory of Open Access Journals (Sweden)

    Wan-Chen Tsai

    2015-01-01

    Full Text Available The Meigs′ syndrome is a rare syndrome defined as the triad of benign solid ovarian tumors, ascites, and pleural effusion, which resolve spontaneously and permanently after tumor resection. Lung collapse due to a large amount of pleural effusion is a common mechanism of death. It always requires surgical treatment. We report an 84-year-old woman with a large ovarian fibroma associated with Meigs′ syndrome and short of breath. It is difficult to diagnose preoperatively and is usually misdiagnosed as an ovarian malignancy. Considering the patient′s serious clinical condition and assuming that she had Meigs′ syndrome with a large ovarian mass and possible lung collapse due to large amount of pleural effusion, we chose the most appropriate surgical treatment after pathologic examination, then enabled definitive diagnosis of the benign tumor and removed the huge ovarian fibroma. This resulted in a timely symptoms resolution, short hospitalization, and relatively low morbidity in elderly.

  4. Theory versus Practice in the Twentieth-Century Search for the Ideal Anaesthetic Gas.

    Science.gov (United States)

    Rae, Ian D

    2016-02-01

    At the beginning of the twentieth century, an anaesthetist could choose between nitrous oxide, chloroform, and ether (diethyl ether) for the induction of painrelieving unconsciousness. By the end of century, the choice was between a small number of fluorinated aliphatic ethers such as Enflurane, Desflurane, and Sevoflurane, and (in some jurisdictions) the rare gas, xenon. Between these endpoints researchers had identified a surprisingly broad range of hydrocarbons, noble gases, organohalogens, and aliphatic ethers that possessed anaesthetic properties. None was entirely satisfactory, but clinicians at various times and in various places employed substances in each of these categories. Behind the search for new anaesthetic gases was a theory of action (Meyer- Overton theory) that was known to be inadequate, but as no alternative was strong enough to displace it the search continued on purely empirical grounds, while lip-service was paid to the theory. By the time a theory couched in more modern terms was proposed, a suite of modern anaesthetic gases was in place, and there have been no attempts to use that theory to drive a new search.

  5. THE USE OF SELECTED ANAESTHETIC DRUGS IN SEARCH OF A METHOD FOR IMPROVING EARTHWORMS’ WELFARE

    Directory of Open Access Journals (Sweden)

    Agnieszka Podolak-Machowska

    2013-07-01

    Full Text Available This paper describes selected effects of body contact of earthworms Dendrobaena veneta Rosa with local anaesthetic (LA drugs used for human anesthesia (lidocaine and prilocaine and anaesthetics for aquatic animals (MS-222. The findings showed safe and effective immobilization of earthworms with prilocaine at a concentration of 0.25-1%. At the applied concentrations lidocaine was safe, but less effective. On the other hand, MS-222, at the applied concentrations had a strongly irritating effect for earthworms and induced convulsive body movements connected with a discharge of coelomic fluid. The results may be relevant both for improving the welfare of earthworms during experiments and for the organization of research involving testing drugs on invertebrates. In this case, by using earthworms as an experimental model and by applying the method for measuring their mobility after contact with anaesthetics, which has been described in this article, it might be possible to replace experiments on guinea pigs, rabbits, rats and mice, which are expensive and require an approval of an ethics committee, with laboratory tests on earthworms.

  6. Scimitar syndrome: Anaesthetic management for pulmonary resection of the unaffected lung.

    Science.gov (United States)

    Fernández-Torres, B; Fernández-López, A; Congregado, M

    2017-12-01

    Scimitar syndrome is a rare congenital anomaly characterized by anomalous drainage of the right pulmonary veins in the inferior vena cava, frequently associated with right lung and pulmonary artery hypoplasia, dextrocardia and abnormal systemic arterial supply to the lower lobe. Pulmonary resection surgery on healthy lung is exceptional, and there are no published records of it, as far as we know. A man with scimitar syndrome diagnosed with a lung nodule with malignant features in the contralateral lung. This situation implies huge anaesthetic complexity, mainly for intraoperative ventilation. Although spirometry and stress test did not contraindicate the planned lobectomy, scintigraphy showed a hypoplastic right lung with an uptake of 15%. From an anaesthetic point of view we discarded selective ventilation of the right lung, since the shunt made it functionally non-existent. In consequence we proposed four anaesthetic possibilities. After the placement of an epidural catheter and left selective intubation, thoracoscopy with intermittent apnoeas was our first choice, and we could complete the extirpation and avoid excessive complexity. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Job satisfaction, stress and burnout in anaesthetic technicians in New Zealand.

    Science.gov (United States)

    Kluger, M T; Bryant, J

    2008-03-01

    Anaesthetic technicians play a key role in the operating room, yet little is known about their levels of job satisfaction or workplace stress. A blinded, confidential single mail-out survey was posted to anaesthetic technicians in New Zealand. The survey consisted of demographic information, a job satisfaction survey, the Maslach Burnout Inventory and the Short Form 12. At total of 154 forms were returned (51% response rate). Respondents worked predominantly in public hospitals and many had duties outside the operating room. Job satisfaction was related to teamwork, practical nature of work and patient contact, while dissatisfaction was related to lack of respect from nurses and limited career pathway. High to moderate levels of emotional exhaustion (48%), depersonalisation (39%) and low levels of personal accomplishment (58%) were indicators of burnout. The Short Form 12 revealed high levels of physical impairment in 24% and emotional impairment in 35% of respondents. These data suggest that work is needed to evaluate anaesthetic assistants' job structure and actively manage their important physical and emotional sequelae.

  8. Anaesthetic properties of carbon monoxide and other gases in relation to plants, insects, and centipedes

    Energy Technology Data Exchange (ETDEWEB)

    Zimmerman, P.W.

    1935-01-01

    The anaesthetic effect of carbon monoxide, carbon dioxide, propylene, butylene, ethylene, and acetylene, when mixed with oxygen, was tested on ten different species of insects and centipedes. The lowest concentrations found to cause anaesthesia are given in per cent by volume as follows: propylene, for centipede, 30; katydid, 75; rose chafer, 60. Carbon monoxide, for centipede, 81.5; katydid, 89, rose chafer, 85. Butylene, for centipede, 5; katydid, 10; rose chafer, 40. Ethylene or acetylene, for centipede, katydid, and rose chafer, 100. Carbon dioxide, for rose chafer, 30. Ethylene was the most effective plant anaesthetic, 0.0005 per cent stopping growth movements of tomato and sunflower plants as shown by motion pictures; 0.001 per cent stopped elongation of sweet pea seedlings, while 0.00001 per cent retarded elongation nearly 50 per cent. The degree of retardation in growth from ethylene gas varied with the concentration and the plant species. Acetylene and propylene were about equally effective as plant anaesthetics. Both were approximately 10 times as effective as carbon monoxide. Mimosa pudica lost its capacity to respond to external stimuli while being exposed to 0.25 per cent of carbon monoxide, but became normal again upon being removed from the gas. 3 references, 4 tables.

  9. 42 CFR 84.79 - Breathing gas; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing gas; minimum requirements. 84.79 Section...-Contained Breathing Apparatus § 84.79 Breathing gas; minimum requirements. (a) Breathing gas used to supply... respiratory tract irritating compounds. (c) Compressed, gaseous breathing air shall meet the applicable...

  10. 42 CFR 84.72 - Breathing tubes; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing tubes; minimum requirements. 84.72...-Contained Breathing Apparatus § 84.72 Breathing tubes; minimum requirements. Flexible breathing tubes used in conjunction with breathing apparatus shall be designed and constructed to prevent: (a) Restriction...

  11. 42 CFR 84.85 - Breathing bags; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing bags; minimum requirements. 84.85 Section...-Contained Breathing Apparatus § 84.85 Breathing bags; minimum requirements. (a) Breathing bags shall have.... (b) Breathing bags shall be constructed of materials which are flexible and resistant to gasoline...

  12. Spontaneous Tumor Lysis Syndrome

    Directory of Open Access Journals (Sweden)

    Alicia C. Weeks MD

    2015-08-01

    Full Text Available Tumor lysis syndrome (TLS is a known complication of malignancy and its treatment. The incidence varies on malignancy type, but is most common with hematologic neoplasms during cytotoxic treatment. Spontaneous TLS is thought to be rare. This case study is of a 62-year-old female admitted with multisystem organ failure, with subsequent diagnosis of aggressive B cell lymphoma. On admission, laboratory abnormalities included renal failure, elevated uric acid (20.7 mg/dL, and 3+ amorphous urates on urinalysis. Oliguric renal failure persisted despite aggressive hydration and diuretic use, requiring initiation of hemodialysis prior to chemotherapy. Antihyperuricemic therapy and hemodialysis were used to resolve hyperuricemia. However, due to multisystem organ dysfunction syndrome with extremely poor prognosis, the patient ultimately expired in the setting of a terminal ventilator wean. Although our patient did not meet current TLS criteria, she required hemodialysis due to uric acid nephropathy, a complication of TLS. This poses the clinical question of whether adequate diagnostic criteria exist for spontaneous TLS and if the lack of currently accepted guidelines has resulted in the underestimation of its incidence. Allopurinol and rasburicase are commonly used for prevention and treatment of TLS. Although both drugs decrease uric acid levels, allopurinol mechanistically prevents formation of the substrate rasburicase acts to solubilize. These drugs were administered together in our patient, although no established guidelines recommend combined use. This raises the clinical question of whether combined therapy is truly beneficial or, conversely, detrimental to patient outcomes.

  13. Environmental contamination and breathing disease

    International Nuclear Information System (INIS)

    Cardona A, Jose D

    2003-01-01

    The atmospheric contamination is the main component of the environmental contamination and it can be defined as the presence in the atmosphere of an or several substances in enough quantity to produce alterations of the health, it is presented in aerosol form, with its gassy and specific components, altering the quality of the population's life and the degradation of the ecosystems. The main pollutant, as much for the frequency as for the importance of its effects, is the smoke of cigarettes. The paper mentions other types of polluting agents and their effects in the breathing apparatus

  14. Sleep disordered breathing in pregnancy

    Directory of Open Access Journals (Sweden)

    Bilgay Izci Balserak

    2015-12-01

    Sleep disordered breathing (SDB is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the severity of SDB, the epidemiology and the risk factors of SDB in pregnancy, the association of SDB with adverse pregnancy outcomes, and screening and management options specific for this population.

  15. Extubation after breathing trials with automatic tube compensation, T-tube, or pressure support ventilation.

    Science.gov (United States)

    Haberthür, C; Mols, G; Elsasser, S; Bingisser, R; Stocker, R; Guttmann, J

    2002-09-01

    Automatic tube compensation (ATC) is a new option to compensate for the pressure drop across the endotracheal or tracheostomy tube (ETT), especially during ventilator-assisted spontaneous breathing. While several benefits of this mode have so far been documented, ATC has not yet been used to predict whether the ETT could be safely removed at the end of weaning, from mechanical ventilation. We undertook a systematic trial using a randomized block design. During a 2-year period, all eligible patients of a medical intensive care unit were treated with ATC, conventional pressure support ventilation (PSV, 5 cmH2O), or T-tube for 2-h. Tolerance of the breathing trial served as a basis for the decision to remove the endotracheal tube. Extubation failure was considered if reintubation was necessary or if the patient required non-invasive ventilatory assistance (both within 48 h). After the inclusion of 90 patients (30 per group) we did not observe significant differences between the modes. Twelve patients failed the initial weaning trial. However, half of the patients who appeared to fail the spontaneous breathing trial on the T-tube, PSV, or both, were successfully extubated after a succeeding trial with ATC. Extubation was thus withheld from four and three of these patients while breathing with PSV or the T-tube, respectively, but to any patient breathing with ATC. It seems that ATC can be used as an alternative mode during the final phase of weaning from mechanical ventilation. Furthermore, this study may promote a larger multicenter trial on weaning with ATC compared with standard modes.

  16. Spontaneous Fluctuations of PO2 in the Rabbit Somatosensory Cortex.

    Science.gov (United States)

    Linsenmeier, Robert A; Aksenov, Daniil P; Faber, Holden M; Makar, Peter; Wyrwicz, Alice M

    2016-01-01

    In many tissues, PO2 fluctuates spontaneously with amplitudes of a few mmHg. Here we further characterized these oscillations. PO2 recordings were made from the whisker barrel cortex of six rabbits with acutely or chronically placed polarographic electrodes. Measurements were made while rabbits were awake and while anesthetized with isoflurane, during air breathing, and during 100% oxygen inspiration. In awake rabbits, 90% of the power was between 0 and 20 cycles per minute (cpm), not uniformly distributed over this range, but with a peak frequently near 10 cpm. This was much slower than heart or respiratory rhythms and is similar to the frequency content observed in other tissues. During hyperoxia, total power was higher than during air-breathing, and the dominant frequencies tended to shift toward lower values (0-10 cpm). These observations suggest that at least the lower frequency fluctuations represent efforts by the circulation to regulate local PO2. There were no consistent changes in total power during 0.5 or 1.5% isoflurane anesthesia, but the power shifted to lower frequencies. Thus, both hyperoxia and anesthesia cause characteristic, but distinct, changes in spontaneous fluctuations. These PO2 fluctuations may be caused by vasomotion, but other factors cannot be ruled out.

  17. The Cerebral Cost of Breathing: An fMRI Case-Study in Congenital Central Hypoventilation Syndrome

    Science.gov (United States)

    Sharman, Mike; Gallea, Cécile; Lehongre, Katia; Galanaud, Damien; Nicolas, Nathalie; Similowski, Thomas; Cohen, Laurent; Straus, Christian; Naccache, Lionel

    2014-01-01

    Certain motor activities - like walking or breathing - present the interesting property of proceeding either automatically or under voluntary control. In the case of breathing, brainstem structures located in the medulla are in charge of the automatic mode, whereas cortico-subcortical brain networks - including various frontal lobe areas - subtend the voluntary mode. We speculated that the involvement of cortical activity during voluntary breathing could impact both on the “resting state” pattern of cortical-subcortical connectivity, and on the recruitment of executive functions mediated by the frontal lobe. In order to test this prediction we explored a patient suffering from central congenital hypoventilation syndrome (CCHS), a very rare developmental condition secondary to brainstem dysfunction. Typically, CCHS patients demonstrate efficient cortically-controlled breathing while awake, but require mechanically-assisted ventilation during sleep to overcome the inability of brainstem structures to mediate automatic breathing. We used simultaneous EEG-fMRI recordings to compare patterns of brain activity between these two types of ventilation during wakefulness. As compared with spontaneous breathing (SB), mechanical ventilation (MV) restored the default mode network (DMN) associated with self-consciousness, mind-wandering, creativity and introspection in healthy subjects. SB on the other hand resulted in a specific increase of functional connectivity between brainstem and frontal lobe. Behaviorally, the patient was more efficient in cognitive tasks requiring executive control during MV than during SB, in agreement with her subjective reports in everyday life. Taken together our results provide insight into the cognitive and neural costs of spontaneous breathing in one CCHS patient, and suggest that MV during waking periods may free up frontal lobe resources, and make them available for cognitive recruitment. More generally, this study reveals how the active

  18. Effects of euphylline on breathing pattern and chemosensitivity of the respiratory system after activation of GABAb-receptors.

    Science.gov (United States)

    Lebedeva, M A; Sanotskaya, N V; Matsievsky, D D

    2010-10-01

    We studied changes in breathing pattern in nembutal-anaesthetized mongrel rats after administration of euphylline against the background of preliminary treatment with lithium hydroxybutyrate. Two types of external respiration responses to euphylline were observed; they depended on the initial blood pressure in systemic circulation and on its drop after euphylline administration. Thus, the reaction of the respiratory system to adenosine receptors blockade against the background of hydroxybutyrate pretreatment was associated with not only the effect of euphylline, but also the state of brain hemodynamics. The effects of euphylline on chemosensitive contour of the respiratory system regulation were also investigated. It was found that euphylline did not abolish desensitization of respiratory system to hypercapnia, but smoothed the response to hypoxia under conditions of GABA(b)-receptor activation.

  19. Spontaneous Intracranial Hypotension

    International Nuclear Information System (INIS)

    Joash, Dr.

    2015-01-01

    Epidemiology is not only rare but an important cause of new daily persistent headaches among young & middle age individuals. The Etiology & Pathogenesis is generally caused by spinal CSF leak. Precise cause remains largely unknown, underlying structural weakness of spinal meninges is suspected. There are several MR Signs of Intracranial Hypotension that include:- diffuse pachymeningeal (dural) enhancement; bilateral subdural, effusion/hematomas; Downward displacement of brain; enlargement of pituitary gland; Engorgement of dural venous sinuses; prominence of spinal epidural venous plexus and Venous sinus thrombosis & isolated cortical vein thrombosis. The sum of volumes of intracranial blood, CSF & cerebral tissue must remain constant in an intact cranium. Treatment in Many cases can be resolved spontaneously or by use Conservative approach that include bed rest, oral hydration, caffeine intake and use of abdominal binder. Imaging Modalities for Detection of CSF leakage include CT myelography, Radioisotope cisternography, MR myelography, MR imaging and Intrathecal Gd-enhanced MR

  20. Spontaneous wave packet reduction

    International Nuclear Information System (INIS)

    Ghirardi, G.C.

    1994-06-01

    There are taken into account the main conceptual difficulties met by standard quantum mechanics in dealing with physical processes involving macroscopic system. It is stressed how J.A.Wheeler's remarks and lucid analysis have been relevant to pinpoint and to bring to its extreme consequences the puzzling aspects of quantum phenomena. It is shown how the recently proposed models of spontaneous dynamical reduction represent a consistent way to overcome the conceptual difficulties of the standard theory. Obviously, many nontrivial problems remain open, the first and more relevant one being that of generalizing the model theories considered to the relativistic case. This is the challenge of the dynamical reduction program. 43 refs, 2 figs

  1. Method for breathing related ECG triggering

    Energy Technology Data Exchange (ETDEWEB)

    Waters, W.; Neeb, W.; Wellner, U.

    1984-02-01

    A method for breathing related ECG triggering has been developed. It can be applied in radionuclid-angiocardioscintigraphy promising new insights into the physiology and pathophysiology of breathing related heart function without invasive manipulations. High resolution images of the heart can be obtained using this method by steering the NMR (nuclear magnetic resonance) or the cine CT (ultrafast transmission computerized tomography) acquisition.

  2. How Does a Hopping Kangaroo Breathe?

    Science.gov (United States)

    Giuliodori, Mauricio J.; Lujan, Heidi L.; Janbaih, Hussein; DiCarlo, Stephen E.

    2010-01-01

    We developed a model to demonstrate how a hopping kangaroo breathes. Interestingly, a kangaroo uses less energy to breathe while hopping than while standing still. This occurs, in part, because rather than using muscle power to move air into and out of the lungs, air is pulled into (inspiration) and pushed out of (expiration) the lungs as the…

  3. Breathing Better with a COPD Diagnosis

    Science.gov (United States)

    ... out of the lungs. Normal luNg CoPD luNg breathiNg better with a CoPD DiagNosis 3 DiagNosis aND ... Using a machine called a spirometer, this noninvasive breathing test measures the amount of air a person ...

  4. The effect of breath freshener strips on two types of breath alcohol testing instruments.

    Science.gov (United States)

    Moore, Ronald L; Guillen, Jennifer

    2004-07-01

    The potential for breath freshener strips to interfere with the accuracy of a breath alcohol test was studied. Twelve varieties of breath freshener strips from five manufacturers were examined. Breath tests were conducted using the infrared based BAC DataMaster or the fuel cell based Alco-Sensor IV-XL, 30 and 150 seconds after placing a breath strip on the tongue. No effect was observed using the Alco-Sensor system. Some of the strips gave a small reading at 30 seconds (less than or equal to 0.010 g/210 L apparent alcohol) using the DataMaster. Readings on the DataMaster returned to zero by the 150 second test. A proper pre-test observation and deprivation period should prevent any interference from breath freshener strips on breath alcohol testing.

  5. Pattern of breathing in brachycephalic dogs.

    Science.gov (United States)

    Amis, T C; Kurpershoek, C

    1986-10-01

    The pattern of breathing was assessed in 19 brachycephalic dogs, using tidal breathing flow-volume loop (TBFVL) analysis. Fifteen dogs had TBFVL consistent with a fixed-type upper airway obstruction, whereas 4 dogs had a TBFVL indicative of a nonfixed upper airway obstruction. The dogs did not have a TBFVL shape the same as that considered normal for healthy nonbrachycephalic dogs. Tidal breathing flow-volume loops from brachycephalic dogs that were considered to have a normal respiratory tract (n = 11) were similar to those of dogs with clinical signs of upper airway obstruction (n = 8). Respiration was monitored continuously for short periods (20 to 50 minutes) in 3 brachycephalic dogs resting in a cage in a quiet, darkened laboratory; 2 of these dogs had periodic breathing patterns characterized by multiple episodes of alternating hypopnea and arousal. Brachycephalic dogs may be at risk for the development of disordered breathing during sleep.

  6. BREATH OF USE AND VOCAL TRAINING

    Directory of Open Access Journals (Sweden)

    Nuran ACAR

    2016-10-01

    Full Text Available Breathable, who escorted us in every aspect of our lives and our survival is our primary activity, allowing for quality of life in a healthy way. quality of breaths taken the right technique, you need both health professional sense should perhaps take advantage of individuals who want to achieve success in life is the primary rule. When the diaphragm is born with assisted breathing lungs of every person's life starts to grow to keep up with the flurry lose this special and important skills. First and foremost, which is important for our body health, including every aspect of proper breathing, especially correct use of the voice carries particular importance. In this article, breathing subject discussed, correct breathing and our lives have tried to give us information about the benefits of both vocal training.

  7. Rapid eye movement sleep in breath holders.

    Science.gov (United States)

    Kohyama, J; Hasegawa, T; Shimohira, M; Fukumizu, M; Iwakawa, Y

    2000-07-01

    One-night polysomnography was performed on seven subjects suffering from breath-holding spells, including one whose death was suggested to be a consequence of a breath-holding spell. The fatal case showed no rapid eye movements (REMs) during REM sleep, although he exhibited REMs during wakefulness. The average numbers of both REMs and bursts of REMs in REM sleep in the other six breath holders were significantly lower than those in age-matched controls. The breath holders showed no airway obstruction, desaturation, or sleep fragmentation. Since the rapid ocular activity in REM sleep is generated in the brain stem, we hypothesized that a functional brainstem disturbance is involved in the occurrence of breath-holding spells.

  8. The Johannesburg A-D circuit switch. A valve device for converting a co-axial Mapleson D into a co-axial Mapleson A system.

    Science.gov (United States)

    Manicom, A W; Schoonbee, C G

    1979-12-01

    A simple valve device is described for a co-axial tubing anaesthetic system which enables selection of the circuit characteristics of either a modified Mapleson A system for spontaneous breathing or a modified Mapleson D system for controlled ventilation. Thus, the system allows an economical fresh gas flow to be used during either controlled or spontaneous ventilation. The mode of ventilation may be changed during anaesthesia without adjusting the patient tubing or the attachment of the system to the anaesthetic machine.

  9. Effect of probenecid on breathing movements and cerebral clearance of prostaglandin E2 in fetal sheep

    Science.gov (United States)

    Walker, David W; Pratt, Naomi

    1998-01-01

    Intravenous infusion of probencid (79-160 mg kg−1) into unanaesthetized fetal sheep (127-143 days gestation) in utero significantly decreased the incidence and amplitude of spontaneous breathing movements, but did not change the incidence of low voltage electrocortical (ECoG) activity, plasma prostaglandin E2 (PGE2) concentrations, blood gases or pH. In fetuses pretreated with paracetamol (350 mg kg−1) to inhibit PG synthase activity, infusion of probenecid did not change the mean incidence or amplitude of breathing movements, indicating that the inhibitory effect of probenecid on breathing movements required the presence of active PG synthesis. Probenecid infusion in four unanaesthetized fetuses significantly increased the PGE2 concentrations in cisternal cerebrospinal fluid (CSF) by 6.6 ± 1.5-fold (P probenecid infusion decreased the clearance of [3H]PGE2 from CSF during ventriculo-cisternal perfusion of artificial CSF containing [3H]PGE2. These results suggest that there is active transport of PGs from CSF to blood in fetal sheep from at least 127 days gestation. Inhibition of this transport results in the accumulation of PGs within interstitial fluid of the brain, one effect of which is to suppress the spontaneous activity of the respiratory centres. PMID:9481686

  10. Ventricular remodelling is a prerequisite for the induction of dofetilide-induced torsade de pointes arrhythmias in the anaesthetized, complete atrio-ventricular-block dog.

    Science.gov (United States)

    Dunnink, Albert; van Opstal, Jurren M; Oosterhoff, Peter; Winckels, Stephan K G; Beekman, Jet D M; van der Nagel, Roel; Cora Verduyn, S; Vos, Marc A

    2012-03-01

    A number of predisposing factors have been suggested to be contributing to drug-induced torsade de pointes (TdP) arrhythmias: short-long-short (SLS) sequence, bradycardia, timing of drug administration, anaesthesia, ventricular remodelling, and altered ventricular activation due to ventricular ectopic beats (SLS) or idioventricular rhythm (IVR). Chronic atrio-ventricular (AV)-block (CAVB) dogs are susceptible to dofetilide-induced TdP. In 32 anaesthetized animals, the relevance of ventricular remodelling for TdP susceptibility was studied by dofetilide [0.025 mg/kg/5 min intravenously (iv)] during bradycardia in the presence (CAVB, n= 18) or absence [acute atrio-ventricular block (AVB), n= 32] of ventricular remodelling. In sub-protocols, the possible pro-arrhythmic effects of timing of dofetilide administration: prior to (n= 11), or after creation of AVB (n= 9) and relevance of SLS pacing (n= 17) was investigated during IVR. Dofetilide was also given after AVB when the activation of the ventricles was normal: pacing (1000 ms) from the high septum (n= 7) or abnormal but fixed from the left ventricular apex (n= 5). Torsade de pointes inducibility was defined as reproducible (≥ 3 times) occurrence. In acute AV block (AAVB), dofetilide did not induce TdP spontaneously (0 of 32), whereas TdP was seen in 10 out of 18 serially tested dogs in CAVB (P< 0.001). The other factors: timing of dofetilide (0 of 11 vs. 0 of 9), SLS pacing (0 of 17 vs. 1 of 17), or ventricular activation (0 of 7 vs. 0 of 5) did not increase TdP susceptibility. Beat-to-beat variability of repolarization increased after ventricular remodelling and was highest prior to TdP induction. In AAVB dogs, TdP is not spontaneously seen, whereas it is present in CAVB. This implies that ventricular remodelling is a prerequisite for TdP induction in this model.

  11. Spontaneous compactification to homogeneous spaces

    International Nuclear Information System (INIS)

    Mourao, J.M.

    1988-01-01

    The spontaneous compactification of extra dimensions to compact homogeneous spaces is studied. The methods developed within the framework of coset space dimensional reduction scheme and the most general form of invariant metrics are used to find solutions of spontaneous compactification equations

  12. Screening for spontaneous preterm birth

    NARCIS (Netherlands)

    van Os, M.A.; van Dam, A.J.E.M.

    2015-01-01

    Preterm birth is the most important cause of perinatal morbidity and mortality worldwide. In this thesis studies on spontaneous preterm birth are presented. The main objective was to investigate the predictive capacity of mid-trimester cervical length measurement for spontaneous preterm birth in a

  13. Spontaneous Pneumomediastinum: Hamman Syndrome

    Directory of Open Access Journals (Sweden)

    Tushank Chadha, BS

    2018-04-01

    significant fat stranding. The image also showed an intraluminal stent traversing the gastric antrum and gastric pylorus with no indication of obstruction. Circumferential mural thickening of the gastric antrum and body were consistent with the patient’s history of gastric adenocarcinoma. The shotty perigastric lymph nodes with associated fat stranding, along the greater curvature of the distal gastric body suggested local regional nodal metastases and possible peritoneal carcinomatosis. The thoracic CT scans showed extensive pneumomediastinum that tracked into the soft tissues of the neck, which given the history of vomiting also raised concern for esophageal perforation. There was still no evidence of mediastinal abscess or fat stranding. Additionally, a left subclavian vein port catheter, which terminates with tip at the cavoatrial junction of the superior vena cava can also be seen on the image. Discussion: Spontaneous Pneumomediastinum, also known as Hamman syndrome, is defined by the uncommon incidence of free air in the mediastinum due to the bursting of alveoli, as a result of extended spells of shouting, coughing, or vomiting.1,2 The condition is diagnosed when a clear cause (aerodigestive rupture, barotrauma, infection secondary to gas-forming organisms3 for pneumomediastinum cannot be clearly identified on diagnostic studies. Macklin and Macklin were the first to note the pathogenesis of the syndrome and explained that the common denominator to spontaneous pneumomediastinum was that increased alveolar pressure leads to alveolar rupture.3 Common clinical findings for spontaneous pneumomediastinum include: chest pain, dyspnea, cough, and emesis.4 The condition is not always readily recognized on initial presentation in part for its rare incidence, estimated to be approximately 1 in every 44,500 ED patients3and also because of the non-specific presenting symptoms. For this patient, there was no clear singular cause, and therefore she received care for spontaneous

  14. Acceleration sensors in abdominal wall position as a non-invasive approach to detect early breathing alterations induced by intolerance of increased airway resistance.

    Science.gov (United States)

    Breuer, Thomas; Bruells, Christian S; Rossaint, Rolf; Steffen, Henning; Disselhorst-Klug, Catherine; Czaplik, Michael; Zoremba, Norbert

    2017-11-10

    Early detection of respiratory overload is crucial to mechanically ventilated patients, especially during phases of spontaneous breathing. Although a diversity of methods and indices has been established, there is no highly specific approach to predict respiratory failure. This study aimed to evaluate acceleration sensors in abdominal and thoracic wall positions to detect alterations in breathing excursions in a setting of gradual increasing airway resistance. Twenty-nine healthy volunteers were committed to a standardized protocol of a two-minutes step-down spontaneous breathing on a 5 mm, 4 mm and then 3 mm orally placed endotracheal tube. Accelerator sensors in thoracic and abdominal wall position monitored breathing excursions. 15 participants passed the breathing protocol ("completed" group), 14 individuals cancelled the protocol due to subjective intolerance to the increasing airway resistance ("abandoned" group). Gradual increased respiratory workload led to a significant decrease of acceleration in abdominal wall position in the "abandoned" group compared to the "completed" group (p breathing alterations prior to respiratory failure. EK 309-15; by the Ethics Committee of the Faculty of Medicine, RWTH Aachen, Aachen, Germany. Retrospectively registered 28th of December 2015.

  15. Horses Auto-Recruit Their Lungs by Inspiratory Breath Holding Following Recovery from General Anaesthesia.

    Science.gov (United States)

    Mosing, Martina; Waldmann, Andreas D; MacFarlane, Paul; Iff, Samuel; Auer, Ulrike; Bohm, Stephan H; Bettschart-Wolfensberger, Regula; Bardell, David

    2016-01-01

    This study evaluated the breathing pattern and distribution of ventilation in horses prior to and following recovery from general anaesthesia using electrical impedance tomography (EIT). Six horses were anaesthetised for 6 hours in dorsal recumbency. Arterial blood gas and EIT measurements were performed 24 hours before (baseline) and 1, 2, 3, 4, 5 and 6 hours after horses stood following anaesthesia. At each time point 4 representative spontaneous breaths were analysed. The percentage of the total breath length during which impedance remained greater than 50% of the maximum inspiratory impedance change (breath holding), the fraction of total tidal ventilation within each of four stacked regions of interest (ROI) (distribution of ventilation) and the filling time and inflation period of seven ROI evenly distributed over the dorso-ventral height of the lungs were calculated. Mixed effects multi-linear regression and linear regression were used and significance was set at pbreath holding until 5 hours after standing. No change from baseline was seen for the distribution of ventilation during inspiration. Filling time and inflation period were more rapid and shorter in ventral and slower and longer in most dorsal ROI compared to baseline, respectively. In a mixed effects multi-linear regression, breath holding was significantly correlated with PaCO2 in both the univariate and multivariate regression. Following recovery from anaesthesia, horses showed inspiratory breath holding during which gas redistributed from ventral into dorsal regions of the lungs. This suggests auto-recruitment of lung tissue which would have been dependent and likely atelectic during anaesthesia.

  16. Spontaneous sigh rates during sedentary activity: watching television vs reading.

    Science.gov (United States)

    Hark, William T; Thompson, William M; McLaughlin, Timothy E; Wheatley, Lisa M; Platts-Mills, Thomas A E

    2005-02-01

    Spontaneous sighs are thought to play an important role in preventing atelectasis and in regulating airway tone. Recent studies have provided a mechanism by which expansion of the lungs could cause relaxation of smooth muscle. To investigate breathing patterns during 2 forms of sedentary behavior: reading and watching television. Breathing patterns were monitored for 1 to 2 hours to document respiratory rates and sigh rates. Each participant was monitored while reading and while watching a movie on videotape. During the first experiment (17 controls), metabolic rates were also measured. In the second experiment (18 controls and 9 patients with mild-to-moderate asthma), only breathing patterns were monitored. There were no significant differences in respiratory or metabolic rates between the 2 activities. In contrast, in the first experiment, 13 of 17 controls had lower sigh rates while watching a videotape than while reading (P < .01). In the second experiment, the sigh rate was significantly lower overall while watching a videotape (mean, 13.7 sighs per hour; range, 1.8-26.0 sighs per hour) than while reading (mean, 19.3 sighs per hour; range, 7.7-30.0 sighs per hour) (P < .001). A similar decrease was observed in patients with asthma (P < .01). Given that many children and adults watch television for 5 or more hours per day, breathing patterns during this time may be relevant to lung function. Our results demonstrate that prolonged periods of watching a videotape are associated with lower sigh rates than while reading. Further research is needed to determine whether these changes are relevant to increased bronchial reactivity.

  17. Sleep disordered breathing in children.

    Science.gov (United States)

    Sinha, Deepti; Guilleminault, Christian

    2010-02-01

    Sleep disordered breathing (SDB) is increasingly being recognised as a cause of morbidity even in young children. With an estimated prevalence of 1 to 4 per cent, SDB results from having a structurally narrow airway combined with reduced neuromuscular tone and increased airway collapsibility. SDB in children differs from adults in a number of ways, including presenting symptoms and treatment. Presentation may differ according to the age of the child. Children have a more varied presentation from snoring and frequent arousals to enuresis to hyperactivity. Those with Down syndrome, midface hypoplasia or neuromuscular disorders are at higher risk for developing SDB. First line definitive treatment in children involves tonsillectomy and adenoidectomy. Rapid maxillary expansion, allergy treatment and continuous positive airway pressure (CPAP) are other options. As untreated SDB results in complications as learning difficulties, memory loss and a long term increase in risk of hypertension, depression and poor growth, it is important to diagnose SDB.

  18. Time Breath of Psychological Theories

    DEFF Research Database (Denmark)

    Tateo, Luca; Valsiner, Jaan

    2015-01-01

    Psychology as a self-aspiring, ambitious, developmental science faces the crucial limit of time—both theoretically and practically. The issue of time in constructing psychology’s theories is a major unresolved metatheoretical task. This raises several questions about generalization of knowledge......: which is the time length of breath of psychological theories? Which is the temporal dimension of psychological processes? In this article we discuss the role of different axiomatic assumptions about time in the construction of psychological theories. How could different theories include a concept...... of time—or fail to do that? How can they generalize with respect to time? The different conceptions of time often remain implicit, while shaping the concepts used in understanding psychological processes. Any preconception about time in human development will foster the generalizability of theory, as well...

  19. The indoor air we breathe.

    Science.gov (United States)

    Oliver, L C; Shackleton, B W

    1998-01-01

    Increasingly recognized as a potential public health problem since the outbreak of Legionnaire's disease in Philadelphia in 1976, polluted indoor air has been associated with health problems that include asthma, sick building syndrome, multiple chemical sensitivity, and hypersensitivity pneumonitis. Symptoms are often nonspecific and include headache, eye and throat irritation, chest tightness and shortness of breath, and fatigue. Air-borne contaminants include commonly used chemicals, vehicular exhaust, microbial organisms, fibrous glass particles, and dust. Identified causes include defective building design and construction, aging of buildings and their ventilation systems, poor climate control, inattention to building maintenance. A major contributory factor is the explosion in the use of chemicals in building construction and furnishing materials over the past four decades. Organizational issues and psychological variables often contribute to the problem and hinder its resolution. This article describes the health problems related to poor indoor air quality and offers solutions.

  20. Fast-starting after a breath: air-breathing motions are kinematically similar to escape responses in the catfish Hoplosternum littorale

    Directory of Open Access Journals (Sweden)

    Paolo Domenici

    2014-12-01

    Full Text Available Fast-starts are brief accelerations commonly observed in fish within the context of predator–prey interactions. In typical C-start escape responses, fish react to a threatening stimulus by bending their body into a C-shape during the first muscle contraction (i.e. stage 1 which provides a sudden acceleration away from the stimulus. Recently, similar C-starts have been recorded in fish aiming at a prey. Little is known about C-starts outside the context of predator–prey interactions, though recent work has shown that escape response can also be induced by high temperature. Here, we test the hypothesis that air-breathing fish may use C-starts in the context of gulping air at the surface. Hoplosternum littorale is an air-breathing freshwater catfish found in South America. Field video observations reveal that their air-breathing behaviour consists of air-gulping at the surface, followed by a fast turn which re-directs the fish towards the bottom. Using high-speed video in the laboratory, we compared the kinematics of the turn immediately following air-gulping performed by H. littorale in normoxia with those of mechanically-triggered C-start escape responses and with routine (i.e. spontaneous turns. Our results show that air-breathing events overlap considerably with escape responses with a large stage 1 angle in terms of turning rates, distance covered and the relationship between these rates. Therefore, these two behaviours can be considered kinematically comparable, suggesting that air-breathing in this species is followed by escape-like C-start motions, presumably to minimise time at the surface and exposure to avian predators. These findings show that C-starts can occur in a variety of contexts in which fish may need to get away from areas of potential danger.

  1. Anaesthetic management of patients undergoing surgery for Moyamoya disease - our institutional experience

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    Vivek B Sharma

    2014-01-01

    Full Text Available Background: Moyamoya disease (MMD is a chronic cerebrovascular disorder, defined as the progressive stenosis or occlusion of the intracranial vessels. Because of the insecure cerebral circulation, these patients represent an anaesthetic challenge. Literature is scarce on the anaesthetic management of MMD, especially from the Indian subcontinent. The main objective of our study was to evaluate the peri-operative course and outcome of patients undergoing surgery for MMD. Materials and Methods: We analysed available medical records of all patients who underwent revascularisation surgeries for MMD over a period of 10 years (January 2002 to June 2012. Various intra- and post-operative data related to anaesthesia were recorded. The patients for the analysis were divided into two groups: Group 1, paediatrics (<18 years and group 2, adults (≥18 years. Data are presented as number (% or mean ± SD or median (range. Results: There were 36 patients (12 adults and 24 children. Normotension, normovolaemia, normo- or mild-hypercapnia and normothermia were maintained in all patients. No patient developed complications or new neurological deficit in the post-operative period. All patients were discharged with a full Glasgow coma scale (GCS and no new neurologic deficit. Conclusion: Although the incidence of MMD is not high in India, it is an important cause of cerebral stroke in children and adults. Proper pre-operative evaluation is the most effective method to achieve good results. Anaesthetic management of MMD should focus on the maintenance of adequate cerebral blood flow and cerebral perfusion pressure ensuring adequate cerebral oxygenation to avoid ischaemic complications.

  2. Mefloquine inhibits voltage dependent Nav1.4 channel by overlapping the local anaesthetic binding site.

    Science.gov (United States)

    Paiz-Candia, Bertin; Islas, Angel A; Sánchez-Solano, Alfredo; Mancilla-Simbro, Claudia; Scior, Thomas; Millan-PerezPeña, Lourdes; Salinas-Stefanon, Eduardo M

    2017-02-05

    Mefloquine constitutes a multitarget antimalaric that inhibits cation currents. However, the effect and the binding site of this compound on Na + channels is unknown. To address the mechanism of action of mefloquine, we employed two-electrode voltage clamp recordings on Xenopus laevis oocytes, site-directed mutagenesis of the rat Na + channel, and a combined in silico approach using Molecular Dynamics and docking protocols. We found that mefloquine: i) inhibited Na v 1.4 currents (IC 50 =60μM), ii) significantly delayed fast inactivation but did not affect recovery from inactivation, iii) markedly the shifted steady-state inactivation curve to more hyperpolarized potentials. The presence of the β1 subunit significantly reduced mefloquine potency, but the drug induced a significant frequency-independent rundown upon repetitive depolarisations. Computational and experimental results indicate that mefloquine overlaps the local anaesthetic binding site by docking at a hydrophobic cavity between domains DIII and DIV that communicates the local anaesthetic binding site with the selectivity filter. This is supported by the fact that mefloquine potency significantly decreased on mutant Na v 1.4 channel F1579A and significantly increased on K1237S channels. In silico this compound docked above F1579 forming stable π-π interactions with this residue. We provide structure-activity insights into how cationic amphiphilic compounds may exert inhibitory effects by docking between the local anaesthetic binding site and the selectivity filter of a mammalian Na + channel. Our proposed synergistic cycle of experimental and computational studies may be useful for elucidating binding sites of other drugs, thereby saving in vitro and in silico resources. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. A preliminary study evaluating cardiac output measurement using Pressure Recording Analytical Method (PRAM) in anaesthetized dogs.

    Science.gov (United States)

    Briganti, Angela; Evangelista, Flavia; Centonze, Paola; Rizzo, Annaliso; Bentivegna, Francesco; Crovace, Antonio; Staffieri, Francesco

    2018-03-06

    Haemodynamic variations normally occur in anaesthetized animals, in relation to the animal status, administered drugs, sympathetic and parasympathetic tone, fluid therapy and surgical stimulus. The possibility to measure some cardiovascular parameters, such as cardiac output (CO), during anaesthesia would be beneficial for both the anaesthesia management and its outcome. New techniques for the monitoring of CO are aimed at finding methods which are non invasive, accurate and with good trending ability, which can be used in a clinical setting. The aim of this study was to compare the Pressure Recording Analytical Method (PRAM) with the pulmonary artery thermodilution (TD) for the measurement of cardiac output in 6 anaesthetized critically ill dogs. Fifty-four pairs of CO measurements were obtained with a median (range) of 3.33 L/min (0.81-7.21) for PRAM-CO and 3.48 L/min (1.41-6.56) for TD-CO. The Bland-Altman analysis showed a mean bias of 0.17 L/min with limits of agreement (LoA) of - 0.46 to 0.81 L/min. The percentage error resulted 18.2%. The 4-quadrant plot analysis showed an acceptable concordance (93%) between the 2 methods. The polar plot showed a good trending ability with the mean angular bias of 3.9° and radial LoA ± 12.1°. The PRAM resulted in good precision, acceptable concordance and good trending ability for the measure of CO in the anaesthetized dog, representing a promising alternative to thermodilution for the measurement of CO. Among all the pulse contour methods available on the market it is the only one that does not require any calibration or adjustment of the measurement. Further studies are required to verify the ability of this method to accurately measure cardiac output even during unstable hemodynamic conditions.

  4. Leakage of volatile anaesthetics from agent-specific keyed vapourizer filling devices.

    Science.gov (United States)

    Davies, J M; Strunin, L; Craig, D B

    1982-09-01

    Agent-specific keyed vapourizer filling devices were designed to ensure that an anaesthetic vapourizer is filled with the correct agent. Since there appear to be no reports of possible loss of volatile agent or operating room pollution resulting from either the design or patterns of use of these devices, measurements were made with three anaesthetic agents and two methods of use. First, two bottles each of methoxyflurane, enflurane and halothane were fitted with a suitable filling device and the weight of agent lost from each bottle over six weeks was measured. Bottle #1 of each agent remained without agitation between weighings; bottle #2 was tipped to mimic filling of a vapourizer. Weight loss over the six week period was 2.76 and 3.15 per cent of the halothane, 2.22 and 2.43 per cent of the enflurane, and 0.58 and 0.96 per cent of the methoxyflurane, for bottles #1 and #2, respectively. Second, pollution was measured with an infra-red analyser for halothane, using bottles #1 and #2, as described above, and a third bottle on which the filling device was replaced by the screw-on cap after each filling of the vapourizer. Vapour loss was undetectable for bottle #1, between 25 and 30 ppm for bottle #2, and between 350 and 400 ppm for bottle #3. Thus, although the design of the filling devices results in loss of the anaesthetic agent, this loss represents potential pollution only when the device is replaced by the screw-on cap between use. Therefore, when using filling devices, these should be left on the bottle of volatile agent between fillings to decrease operating room pollution.

  5. Anaesthetic impairment of immune function is mediated via GABA(A receptors.

    Directory of Open Access Journals (Sweden)

    Daniel W Wheeler

    2011-02-01

    Full Text Available GABA(A receptors are members of the Cys-loop family of neurotransmitter receptors, proteins which are responsible for fast synaptic transmission, and are the site of action of wide range of drugs. Recent work has shown that Cys-loop receptors are present on immune cells, but their physiological roles and the effects of drugs that modify their function in the innate immune system are currently unclear. We are interested in how and why anaesthetics increase infections in intensive care patients; a serious problem as more than 50% of patients with severe sepsis will die. As many anaesthetics act via GABA(A receptors, the aim of this study was to determine if these receptors are present on immune cells, and could play a role in immunocompromising patients.We demonstrate, using RT-PCR, that monocytes express GABA(A receptors constructed of α1, α4, β2, γ1 and/or δ subunits. Whole cell patch clamp electrophysiological studies show that GABA can activate these receptors, resulting in the opening of a chloride-selective channel; activation is inhibited by the GABA(A receptor antagonists bicuculline and picrotoxin, but not enhanced by the positive modulator diazepam. The anaesthetic drugs propofol and thiopental, which can act via GABA(A receptors, impaired monocyte function in classic immunological chemotaxis and phagocytosis assays, an effect reversed by bicuculline and picrotoxin.Our results show that functional GABA(A receptors are present on monocytes with properties similar to CNS GABA(A receptors. The functional data provide a possible explanation as to why chronic propofol and thiopental administration can increase the risk of infection in critically ill patients: their action on GABA(A receptors inhibits normal monocyte behaviour. The data also suggest a potential solution: monocyte GABA(A receptors are insensitive to diazepam, thus the use of benzodiazepines as an alternative anesthetising agent may be advantageous where infection is a life

  6. Anaesthetic impairment of immune function is mediated via GABA(A) receptors.

    Science.gov (United States)

    Wheeler, Daniel W; Thompson, Andrew J; Corletto, Federico; Reckless, Jill; Loke, Justin C T; Lapaque, Nicolas; Grant, Andrew J; Mastroeni, Pietro; Grainger, David J; Padgett, Claire L; O'Brien, John A; Miller, Nigel G A; Trowsdale, John; Lummis, Sarah C R; Menon, David K; Beech, John S

    2011-02-24

    GABA(A) receptors are members of the Cys-loop family of neurotransmitter receptors, proteins which are responsible for fast synaptic transmission, and are the site of action of wide range of drugs. Recent work has shown that Cys-loop receptors are present on immune cells, but their physiological roles and the effects of drugs that modify their function in the innate immune system are currently unclear. We are interested in how and why anaesthetics increase infections in intensive care patients; a serious problem as more than 50% of patients with severe sepsis will die. As many anaesthetics act via GABA(A) receptors, the aim of this study was to determine if these receptors are present on immune cells, and could play a role in immunocompromising patients. We demonstrate, using RT-PCR, that monocytes express GABA(A) receptors constructed of α1, α4, β2, γ1 and/or δ subunits. Whole cell patch clamp electrophysiological studies show that GABA can activate these receptors, resulting in the opening of a chloride-selective channel; activation is inhibited by the GABA(A) receptor antagonists bicuculline and picrotoxin, but not enhanced by the positive modulator diazepam. The anaesthetic drugs propofol and thiopental, which can act via GABA(A) receptors, impaired monocyte function in classic immunological chemotaxis and phagocytosis assays, an effect reversed by bicuculline and picrotoxin. Our results show that functional GABA(A) receptors are present on monocytes with properties similar to CNS GABA(A) receptors. The functional data provide a possible explanation as to why chronic propofol and thiopental administration can increase the risk of infection in critically ill patients: their action on GABA(A) receptors inhibits normal monocyte behaviour. The data also suggest a potential solution: monocyte GABA(A) receptors are insensitive to diazepam, thus the use of benzodiazepines as an alternative anesthetising agent may be advantageous where infection is a life

  7. Adrenaline reveals the torsadogenic effect of combined blockade of potassium channels in anaesthetized guinea pigs.

    Science.gov (United States)

    Michael, G; Kane, K A; Coker, S J

    2008-08-01

    Torsade de pointes (TdP) can be induced in several species by a reduction in cardiac repolarizing capacity. The aim of this study was to assess whether combined I(Kr) and I(Ks) blockade could induce TdP in anaesthetized guinea pigs and whether short-term variability (STV) or triangulation of action potentials could predict TdP. Experiments were performed in open-chest, pentobarbital-anaesthetized, adrenaline-stimulated male Dunkin Hartley guinea pigs, which received three consecutive i.v. infusions of either vehicle, the I(Kr) blocker E-4031 (3, 10 and 30 nmol kg(-1) min(-1)), the I(Ks) blocker HMR1556 (75, 250, 750 nmol kg(-1) min(-1)) or E-4031 and HMR1556 combined. Phenylephrine-stimulated guinea pigs were also treated with the K(+) channel blockers in combination. Arterial blood pressure, ECGs and epicardial monophasic action potential (MAP) were recorded. TdP was observed in 75% of adrenaline-stimulated guinea pigs given the K(+) channel blockers in combination, but was not observed in guinea pigs treated with either I(K) blocker alone, or in phenylephrine-stimulated guinea pigs. Salvos and ventricular tachycardia occurred with adrenaline but not with phenylephrine. No changes in STV or triangulation of the MAP signals were observed before TdP. Combined blockade of both I(Kr) and I(Ks) plus the addition of adrenaline were required to induce TdP in anaesthetized guinea pigs. This suggests that there must be sufficient depletion of repolarization reserve and an appropriate trigger for TdP to occur.

  8. Possible mechanisms of hypotension produced 70% alcoholic extract of Terminalia arjuna (L. in anaesthetized dogs

    Directory of Open Access Journals (Sweden)

    Lodagala Durga S

    2003-10-01

    Full Text Available Abstract Background The bark of Terminalia arjuna L. (Combretaceae is used in Ayurveda since ancient times for the treatment of cardiac disorders. Previous laboratory investigations have demonstrated the use of the bark in cardiovascular complications. The present study was aimed to find the effect of 70% alcoholic extract of Terminalia arjuna on anaesthetized dog blood pressure and probable site of action. Methods Six dogs were anaesthetized with intraperitoneal injection of thiopental sodium and the blood pressure of each dog (n = 6 was measured from the left common carotid artery connected to a mercury manometer on kymograph. The femoral vein was cannulated for administration of drug solutions. The extract of T. arjuna (dissolved in propylene glycol in the dose range of 5 to 15 mg/kg were administered intravenously in a pilot study and the dose (6 mg/kg which produced appreciable hypotension was selected for further studies. Results Intravenous administration of T. arjuna produced dose-dependent hypotension in anaesthetized dogs. The hypotension produced by 6 mg/kg dose of the extract was blocked by propranolol but not by atropine or mepyramine maleate. This indicates that muscarinic or histaminergic mechanisms are not likely to be involved in the hypotension produced by the extract. The blockade by propranolol of the hypotension produced by T. arjuna indicates that the extract might contain active compound(s possessing adrenergic ß2-receptor agonist action and/or that act directly on the heart muscle. Conclusion The results indicated the likely involvement of peripheral mechanism for hypotension produced by the 70% alcoholic extract of Terminalia arjuna and lends support for the claims of its traditional usage in cardiovascular disorders.

  9. Anaesthetic Management of Supratentorial Tumor Craniotomy Using Awake-Throughout Approach.

    Science.gov (United States)

    Shafiq, Faraz; Salim, Fahad; Enam, Ather; Parkash, Jai; Faheem, Mohammad

    2017-12-01

    The authors are reporting an anaesthetic management of patient presenting with left parietal lobe space occupying lesion and scheduled for Awake-craniotomy. Awake-throughout approach using scalp block was planned. Among techniques reported for keeping patient awake during the surgery, this one is really underutilized. The successful conduct requires thorough preoperative assessment and psychological preparation. We used powerpoint presentation as a preoperative teaching tool. The anatomical landmark technique was used to institute scalp block, where individual nerves were targeted bilaterally. Patient remained stable throughout and participated actively in intraoperative neurological monitoring. Postoperative period showed remarkable recovery, better pain control, and shorter length of stay in hospital.

  10. Morbidly obese patient with obstructive sleep apnoea for major spine surgery: An anaesthetic challenge

    Directory of Open Access Journals (Sweden)

    Shruti Redhu

    2016-01-01

    Full Text Available Morbidly obese patients with clinical features of obstructive sleep apnoea can present a myriad of challenges to the anaesthesiologists which must be addressed to minimise the perioperative risks. Initiation of continuous positive airway pressure (CPAP therapy early in the pre- and post-operative period along with appropriate anaesthetic planning is of paramount importance in such patients. This case report emphasises the usefulness of CPAP therapy, even for a short duration, to minimise morbidity, improve recovery and hasten early discharge from the hospital after major surgery.

  11. Effectiveness of Two Topical Anaesthetic Agents used along with Audio Visual Aids in Paediatric Dental Patients.

    Science.gov (United States)

    Agarwal, Nidhi; Dhawan, Jayata; Kumar, Dipanshu; Anand, Ashish; Tangri, Karan

    2017-01-01

    Topical anaesthetic agents enable pain free intraoral procedures, symptomatic pain relief for toothache, superficial mucosal lesions and pain related to post extraction time. Most common anxiety provoking and fearful experience for children in dental operatory is administration of local anaesthesia because on seeing the needle, children usually become uncooperative. One of recent trend of behaviour management technique is using non-aversive techniques out of which audiovisual distraction has emerged as a very successful technique for managing children in dental settings. Audio visual distraction could decrease the procedure related anxiety of patients undergoing dental treatment and can be very relaxing for highly anxious patients. The aim of the present study was to compare the efficacy of topical anaesthetics EMLA (Eutectic Mixture of Local Anaesthetics) cream and benzocaine (20%) gel in reducing the pain during the needle insertion with and without the use of Audio Visual (AV) aids. The study was conducted on 120 children, the age range of 3-14 years attending the outpatient department for their treatment. EMLA and benzocaine gel (20%) were assessed for their effectiveness in reducing the pain on needle insertion during local anaesthesia administration. Based on the inclusion and the exclusion criteria, children requiring local anaesthesia for the dental treatment were randomly divided into four equal groups of 30 children based upon whether AV aids were used or not. AV aids were given using Sony Vaio laptop with earphones with nursery rhymes and cartoon movies DVD. The pain assessment was done by using the Visual Analogue Scale (VAS) scale and measurement of the physiological responses of pulse rate and oxygen saturation were done by pulse oximeter. There was a statistically significant difference in the mean pain score, pulse rate and mean oxygen saturation rate when it was compared between the four groups. EMLA with AV aids was found to be a better topical

  12. Efficacy of 2-Phenoxyethanol as an Anaesthetic for Adult Redline Torpedo Fish, Sahyadria denisonii (Day 1865

    Directory of Open Access Journals (Sweden)

    Anna Mercy Thoranam Varkey

    2014-01-01

    Full Text Available Efficacy of 2-phenoxyethanol for redline torpedo fish exposed to five concentrations (200, 300, 400, 500, and 600 μlL−1 was evaluated. The time periods necessary for each characteristic stage of induction and recovery were recorded. Results indicated that the induction time of the fish exposed to five anaesthetic concentrations significantly (P<0.05 decreased with increasing concentration but recovery time was independent of concentration. Concentration of 500 μlL−1 (induction time: 173 ± 7 and recovery time: 129 ± 41 seconds was determined as the minimum effective concentration that induces anaesthesia in less than 3 minutes.

  13. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E

    2012-02-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  14. Anaesthetic management of a patient with Liddle's syndrome for emergency caesarean hysterectomy.

    LENUS (Irish Health Repository)

    Hayes, N E

    2011-04-01

    We describe the anaesthetic management of a patient with Liddle\\'s syndrome during caesarean section and emergency hysterectomy for placenta accreta associated with significant intrapartum haemorrhage. Liddle\\'s syndrome is a rare autosomal dominant disorder characterised by early onset arterial hypertension and hypokalaemic metabolic alkalosis. Additional issues were the presence of short stature, limb hypertonicity and preeclampsia. Initial management with a low-dose combined spinal-epidural technique was subsequently converted to general anaesthesia due to patient discomfort. The management of Liddle\\'s syndrome in the setting of neuraxial and general anaesthesia in a patient undergoing caesarean section is discussed.

  15. Financial and environmental costs of reusable and single-use anaesthetic equipment.

    Science.gov (United States)

    McGain, F; Story, D; Lim, T; McAlister, S

    2017-06-01

    An innovative approach to choosing hospital equipment is to consider the environmental costs in addition to other costs and benefits. We used life cycle assessment to model the environmental and financial costs of different scenarios of replacing reusable anaesthetic equipment with single-use variants. The primary environmental costs were CO 2 emissions (in CO 2 equivalents) and water use (in litres). We compared energy source mixes between Australia, the UK/Europe, and the USA. For an Australian hospital with six operating rooms, the annual financial cost of converting from single-use equipment to reusable anaesthetic equipment would be an AUD$32 033 (£19 220), 46% decrease. In Australia, converting from single-use to reusable equipment would result in an increase of CO 2 emissions from 5095 (95% CI: 4614-5658) to 5575 kg CO 2 eq (95% CI: 5542-5608), a 480 kg CO 2 eq (9%) increase. Using the UK/European power mix, converting from single-use (5575 kg CO 2 eq) to reusable anaesthetic equipment (802 kg CO 2 eq) would result in an 84% reduction (4873 kg CO 2 eq) in CO 2 emissions, whilst in the USA converting to reusables would have led to a 2427 kg CO 2 eq (48%) reduction. In Australia, converting from single-use to reusable equipment would more than double water use from 34.4 to 90.6 kilolitres. For an Australian hospital with six operating rooms, converting from single-use to reusable anaesthetic equipment saved more than AUD$30 000 (£18 000) per annum, but increased the CO 2 emissions by almost 10%. The CO 2 offset is highly dependent on the power source mix, while water consumption is greater for reusable equipment. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  16. Anaesthetic Implications in Primary Hyperparathyroidism with Severe Hypercalcaemia; a Case Report

    Directory of Open Access Journals (Sweden)

    Pranav Bansal

    2013-07-01

    Full Text Available Primary hyperparathyroidism is a rare endocrinal disorder of excess production of parathormone. A wide array of presenting symptoms may occur from parathormone induced hypercalcaemia leading to nephrolithiasis, osteoporosis, muscle weakness and cardiac arrhythmias. We present a case of young female who presented with non union of an operated fracture femur and generalized bony pains and frequent complaints of vomiting, polyuria and polydipsia. She was diagnosed to have primary hyperparathyroidism with hypercalcaemia and underwent parathyroidectomy. The potential perioperative problems and anaesthetic concerns require a focused management and are discussed.

  17. Anaesthetic Implications in Primary Hyperparathyroidism with Severe Hypercalcaemia: a Case Report

    Directory of Open Access Journals (Sweden)

    Pranav Bansal

    2013-07-01

    Full Text Available Primary hyperparathyroidism is a rare endocrinal disorder of excess production of parathormone. A wide array of presenting symptoms may occur from parathormone induced hypercalcaemia leading to nephrolithiasis, osteoporosis, muscle weakness and cardiac arrhythmias. We present a case of young female who presented with non union of an operated fracture femur and generalized bony pains and frequent complaints of vomiting, polyuria and polydipsia. She was diagnosed to have primary hyperparathyroidism with hypercalcaemia and underwent parathyroidectomy. The potential perioperative problems and anaesthetic concerns are discussed.

  18. Monitoring variables affecting positron emission tomography measurements of cerebral blood flow in anaesthetized pigs

    DEFF Research Database (Denmark)

    Alstrup, Aage Kristian Olsen; Zois, Nora Elisabeth; Simonsen, Mette

    2018-01-01

    Background Positron emission tomography (PET) imaging of anaesthetized pig brains is a useful tool in neuroscience. Stable cerebral blood flow (CBF) is essential for PET, since variations can affect the distribution of several radiotracers. However, the effect of physiological factors regulating...... and the monitoring parameters. Results No significant statistical correlations were found between CBF and the nine monitoring variables. However, we found that arterial carbon dioxide tension (PaCO2) and body temperature were important predictors of CBF that should be observed and kept constant. In addition, we...

  19. The value of decision tree analysis in planning anaesthetic care in obstetrics.

    Science.gov (United States)

    Bamber, J H; Evans, S A

    2016-08-01

    The use of decision tree analysis is discussed in the context of the anaesthetic and obstetric management of a young pregnant woman with joint hypermobility syndrome with a history of insensitivity to local anaesthesia and a previous difficult intubation due to a tongue tumour. The multidisciplinary clinical decision process resulted in the woman being delivered without complication by elective caesarean section under general anaesthesia after an awake fibreoptic intubation. The decision process used is reviewed and compared retrospectively to a decision tree analytical approach. The benefits and limitations of using decision tree analysis are reviewed and its application in obstetric anaesthesia is discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Magnetic resonance imaging targeted transperineal prostate biopsy: a local anaesthetic approach.

    Science.gov (United States)

    Bass, E J; Donaldson, I A; Freeman, A; Jameson, C; Punwani, S; Moore, C; Arya, M; Emberton, M; Ahmed, H U

    2017-09-01

    Despite high rates of disease misclassification and sepsis, the use of transrectal biopsy remains commonplace. Transperineal mapping biopsies mitigate these problems but carry increased cost and patient burden. Local anaesthetic, multiparametric magnetic resonance imaging (MRI)-targeted transperineal biopsy may offer an alternative. Here, we aim to determine the feasibility, tolerability and detection rates of clinically significant prostate cancer using a local anaesthetic, transperineal, MRI-targeted biopsy technique. Tertiary referral centre in which 181 consecutive men underwent local anaesthetic, transperineal MRI-targeted prostate biopsy (September 2014 to January 2016). A standardized local anaesthetic technique was used to obtain targeted biopsies using visual estimation with the number of targeted cores determined by each of a number of users. We assessed adverse events, patient visual analogue pain scores and detection rates of clinically significant cancer (defined by University College London (UCL) definitions one and two and separately by the presence of dominant and non-dominant Gleason pattern 4). We secondarily assessed detection of any cancer, rates of detection by MRI (Likert) score and by presenting PSA. Differences were assessed using Chi-squared tests (P<0.05). One hundred eighty-one men with 243 lesions were included. There were no episodes of sepsis or re-admissions and one procedure was abandoned owing to patient discomfort. Twenty-three out of 25 (92%) men would recommend the procedure to another. Median visual analogue pain score was 1.0 (interquartile range: 0.0-2.4). A total 104/181 (57%) had UCL definition 1 disease (Gleason ⩾4+3 and/or maximum cancer length ⩾6 mm) and 129/181 (71%) had UCL definition 2 cancer (Gleason ⩾3+4 and/or maximum cancer length ⩾4 mm). Fifty-four out of 181 (30%) and 124/181 (69%) had dominant and non-dominant pattern 4 disease or greater (irrespective of cancer length). Any cancer was

  1. Anaesthetic management of a patient with deep brain stimulation implant for radical nephrectomy

    Directory of Open Access Journals (Sweden)

    Monica Khetarpal

    2014-01-01

    Full Text Available A 63-year-old man with severe Parkinson′s disease (PD who had been implanted with deep brain stimulators into both sides underwent radical nephrectomy under general anaesthesia with standard monitoring. Deep brain stimulation (DBS is an alternative and effective treatment option for severe and refractory PD and other illnesses such as essential tremor and intractable epilepsy. Anaesthesia in the patients with implanted neurostimulator requires special consideration because of the interaction between neurostimulator and the diathermy. The diathermy can damage the brain tissue at the site of electrode. There are no standard guidelines for the anaesthetic management of a patient with DBS electrode in situ posted for surgery.

  2. The analysis of variance in anaesthetic research: statistics, biography and history.

    Science.gov (United States)

    Pandit, J J

    2010-12-01

    Multiple t-tests (or their non-parametric equivalents) are often used erroneously to compare the means of three or more groups in anaesthetic research. Methods for correcting the p value regarded as significant can be applied to take account of multiple testing, but these are somewhat arbitrary and do not avoid several unwieldy calculations. The appropriate method for most such comparisons is the 'analysis of variance' that not only economises on the number of statistical procedures, but also indicates if underlying factors or sub-groups have contributed to any significant results. This article outlines the history, rationale and method of this analysis.

  3. Systems analysis of voluntary reported anaesthetic safety incidents occurring in a university teaching hospital.

    Science.gov (United States)

    McMillan, Matthew W; Lehnus, Kristina S

    2018-01-01

    To identify factors contributing to the development of anaesthetic safety incidents. Prospective, descriptive, voluntary reporting audit of safety incidents with subsequent systems analysis. All animals anaesthetized in a multispecies veterinary teaching hospital from November 2014 to October 2016. Peri-anaesthetic incidents that risked or caused unnecessary harm to an animal were reported by anaesthetists alongside animal morbidity and mortality data. A modified systems analysis framework was used to identify contributing factors from the following categories: Animal and Owner, Task and Technology, Individual, Team, Work Environmental, and Organizational and Management. The outcome was graded using a simple descriptive scale. Data were analysed using Pearson's Chi-Square test for association and univariable and multivariable logistic regression analysis. Totally, 3379 anaesthetics were performed during the audit period. Of these, 174 incident reports were analysed, 163 of which impacted safe veterinary care and 26 incidents were considered to have had major or catastrophic outcomes. Incident outcome was believed to have been limited by anaesthetist intervention in 104 (63.8%) cases. Various factors were identified as: Individual in 123 (70.7%), Team in 108 (62.1%), Organizational and Management in 94 (54.0%), Task and Technology in 80 (46.0%), Work Environmental in 53 (30.5%) and Animal and Owner in 36 (20.7%) incidents. Individual factors were rarely seen in isolation. Significant associations were identified between Experience and Supervision, X 2 (1, n=174)=54177, p=0.001, Failure to follow a standard operating procedure and Task Management, X 2 (2, n=174)=11318, p=0.001, and Staffing and Poor Scheduling, X 2 (1, n=174)=36742, p=0.001. Animal Condition [odds ratio (OR)=16210, 95% confidence interval (CI)=5573-47147)] and anaesthetist Decision Making (OR=3437, 95% CI=1184-9974) were risk factors for catastrophic and major outcomes. Individual factors contribute

  4. Immediate effects of breath holding maneuvers onto composition of exhaled breath.

    Science.gov (United States)

    Sukul, Pritam; Trefz, Phillip; Schubert, Jochen K; Miekisch, Wolfram

    2014-09-01

    Rapid concentration changes due to physiological or pathophysiological effects rather than appearance of unique disease biomarkers are important for clinical application of breath research. Simple maneuvers such as breath holding may significantly affect breath biomarker concentrations. In this study, exhaled volatile organic compound (VOC) concentrations were assessed in real time before and after different breath holding maneuvers. Continuous breath-resolved measurements (PTR-ToF-MS-8000) were performed in 31 healthy human subjects in a side-stream sampling mode. After 1 min of tidal breathing participants held their breath for 10, 20, 40, 60 s and as long as possible. Afterwards they continued to breathe normally for another minute. VOC profiles could be monitored in real time by assigning online PTR-ToF-MS data to alveolar or inspired phases of breath. Sudden and profound changes of exhaled VOC concentrations were recorded after different breath holding maneuvers. VOC concentrations returned to base line levels 10-20 s after breath holding. Breath holding induced concentration changes depended on physico-chemical properties of the substances. When substance concentrations were normalized onto end-tidal CO2 content, variation of acetone concentrations decreased, whereas variations of isoprene concentrations were not affected. As the effects of breathing patterns on exhaled substance concentrations depend on individual substance properties, sampling procedures have to be validated for each compound by means of appropriate real-time analysis. Normalization of exhaled concentrations onto exhaled CO2 is only valid for substances having similar physico-chemical properties as CO2.

  5. Spontaneous breaking of supersymmetry

    Energy Technology Data Exchange (ETDEWEB)

    Zumino, B.

    1981-12-01

    There has been recently a revival of interest in supersymmetric gauge theories, stimulated by the hope that supersymmetry might help in clarifying some of the questions which remain unanswered in the so called Grand Unified Theories and in particular the gauge hierarchy problem. In a Grand Unified Theory one has two widely different mass scales: the unification mass M approx. = 10/sup 15/GeV at which the unification group (e.g. SU(5)) breaks down to SU(3) x SU(2) x U(1) and the mass ..mu.. approx. = 100 GeV at which SU(2) x U(1) is broken down to the U(1) of electromagnetism. There is at present no theoretical understanding of the extreme smallness of the ratio ..mu../M of these two numbers. This is the gauge hierarchy problem. This lecture attempts to review the various mechanisms for spontaneous supersymmetry breaking in gauge theories. Most of the discussions are concerned with the tree approximation, but what is presently known about radiative correction is also reviewed.

  6. Spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Haritanti, A.; Karacostas, D.; Drevelengas, A.; Kanellopoulos, V.; Paraskevopoulou, E.; Lefkopoulos, A.; Economou, I.; Dimitriadis, A.S.

    2009-01-01

    Spontaneous intracranial hypotension (SIH) is an uncommon but increasingly recognized syndrome. Orthostatic headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delayed diagnosis of this condition may subject patients to unnecessary procedures and prolong morbidity. We describe six patients with SIH and outline the important clinical and neuroimaging findings. They were all relatively young, 20-54 years old, with clearly orthostatic headache, minimal neurological signs (only abducent nerve paresis in two) and diffuse pachymeningeal gadolinium enhancement on brain MRI, while two of them presented subdural hygromas. Spinal MRI was helpful in detecting a cervical cerebrospinal fluid leak in three patients and dilatation of the vertebral venous plexus with extradural fluid collection in another. Conservative management resulted in rapid resolution of symptoms in five patients (10 days-3 weeks) and in one who developed cerebral venous sinus thrombosis, the condition resolved in 2 months. However, this rapid clinical improvement was not accompanied by an analogous regression of the brain MR findings that persisted on a longer follow-up. Along with recent literature data, our patients further point out that SIH, to be correctly diagnosed, necessitates increased alertness by the attending physician, in the evaluation of headaches

  7. Spontaneous lateral temporal encephalocele.

    Science.gov (United States)

    Tuncbilek, Gokhan; Calis, Mert; Akalan, Nejat

    2013-01-01

    A spontaneous encephalocele is one that develops either because of embryological maldevelopment or from a poorly understood postnatal process that permits brain herniation to occur. We here report a rare case of lateral temporal encephalocele extending to the infratemporal fossa under the zygomatic arch. At birth, the infant was noted to have a large cystic mass in the right side of the face. After being operated on initially in another center in the newborn period, the patient was referred to our clinic with a diagnosis of temporal encephalocele. He was 6 months old at the time of admission. Computerized tomography scan and magnetic resonance imaging studies revealed a 8 × 9 cm fluid-filled, multiloculated cystic mass at the right infratemporal fossa. No intracranial pathology or connection is seen. The patient was operated on to reduce the distortion effect of the growing mass. The histopathological examination of the sac revealed well-differentiated mature glial tissue stained with glial fibrillary acid protein. This rare clinical presentation of encephaloceles should be taken into consideration during the evaluation of the lateral facial masses in the infancy period, and possible intracranial connection should be ruled out before surgery to avoid complications.

  8. Breathing changes accompanying balance improvement during biofeedback.

    Science.gov (United States)

    Hirjaková, Zuzana; Neumannová, Kateřina; Kimijanová, Jana; Šuttová, Kristína; Janura, Miroslav; Hlavačka, František

    2017-06-09

    The aim of this study was to determine whether respiration would be altered during visual biofeedback condition while standing on a foam surface. Fifty young, healthy subjects (24 men, 26 women) were divided into a spirometry group, in which additional spirometry analysis was performed, and a control group. All subjects were tested in two conditions: 1) standing on a foam surface and 2) standing on a foam surface with visual biofeedback (VF) based on the centre of pressure (CoP). CoP amplitude and velocity in anterior-posterior (Aap, Vap) and medial-lateral (Aml, Vml) directions were measured by the force platform. Breathing movements were recorded by two pairs of 3D accelerometers attached on the upper chest (upper chest breathing - UCB) and the lower chest (lower chest breathing - LCB). Results showed that significant decreases of CoP amplitude and velocity in both directions were accompanied by a significant decrease of lower chest breathing, and an increase of LCB frequency was seen during VF condition compared to control condition in both groups. Moreover, a significant decrease in tidal volume and increased breathing frequency during VF condition were confirmed by spirometric analysis. Reduced breathing movements and volumes as well as increased breathing frequency are probably part of an involuntary strategy activated to maximize balance improvement during VF condition. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Air sampling unit for breath analyzers

    Science.gov (United States)

    Szabra, Dariusz; Prokopiuk, Artur; Mikołajczyk, Janusz; Ligor, Tomasz; Buszewski, Bogusław; Bielecki, Zbigniew

    2017-11-01

    The paper presents a portable breath sampling unit (BSU) for human breath analyzers. The developed unit can be used to probe air from the upper airway and alveolar for clinical and science studies. The BSU is able to operate as a patient interface device for most types of breath analyzers. Its main task is to separate and to collect the selected phases of the exhaled air. To monitor the so-called I, II, or III phase and to identify the airflow from the upper and lower parts of the human respiratory system, the unit performs measurements of the exhaled CO2 (ECO2) in the concentration range of 0%-20% (0-150 mm Hg). It can work in both on-line and off-line modes according to American Thoracic Society/European Respiratory Society standards. A Tedlar bag with a volume of 5 dm3 is mounted as a BSU sample container. This volume allows us to collect ca. 1-25 selected breath phases. At the user panel, each step of the unit operation is visualized by LED indicators. This helps us to regulate the natural breathing cycle of the patient. There is also an operator's panel to ensure monitoring and configuration setup of the unit parameters. The operation of the breath sampling unit was preliminarily verified using the gas chromatography/mass spectrometry (GC/MS) laboratory setup. At this setup, volatile organic compounds were extracted by solid phase microextraction. The tests were performed by the comparison of GC/MS signals from both exhaled nitric oxide and isoprene analyses for three breath phases. The functionality of the unit was proven because there was an observed increase in the signal level in the case of the III phase (approximately 40%). The described work made it possible to construct a prototype of a very efficient breath sampling unit dedicated to breath sample analyzers.

  10. Bilateral spontaneous carotid artery dissection.

    Science.gov (United States)

    Townend, Bradley Scott; Traves, Laura; Crimmins, Denis

    2005-06-01

    Bilateral internal carotid artery dissections have been reported, but spontaneous bilateral dissections are rare. Internal carotid artery dissection can present with a spectrum of symptoms ranging from headache to completed stroke. Two cases of spontaneous bilateral carotid artery dissection are presented, one with headache and minimal symptoms and the other with a stroke syndrome. No cause could be found in either case, making the dissections completely spontaneous. Bilateral internal carotid artery dissection (ICAD) should be considered in young patients with unexplained head and neck pain with or without focal neurological symptoms and signs. The increasing availability of imaging would sustain the higher index of suspicion.

  11. Effect of different breathing aids on ventilation distribution in adults with cystic fibrosis.

    Directory of Open Access Journals (Sweden)

    Markus Wettstein

    Full Text Available BACKGROUND AND OBJECTIVES: We investigated the effect of different breathing aids on ventilation distribution in healthy adults and subjects with cystic fibrosis (CF. METHODS: In 11 healthy adults and 9 adults with CF electrical impedance tomography measurements were performed during spontaneous breathing, continuous positive airway pressure (CPAP and positive expiratory pressure (PEP therapy randomly applied in upright and lateral position. Spatial and temporal ventilation distribution was assessed. RESULTS: The proportion of ventilation directed to the dependent lung significantly increased in lateral position compared to upright in healthy and CF. This effect was enhanced with CPAP but neutralised with PEP, whereas the effect of PEP was larger in the healthy group. Temporal ventilation distribution showed exactly the opposite with homogenisation during CPAP and increased inhomogeneity with PEP. CONCLUSIONS: PEP shows distinct differences to CPAP with respect to its impact on ventilation distribution in healthy adults and CF subjects EIT might be used to individualise respiratory physiotherapy.

  12. Is breath acetone a biomarker of diabetes? A historical review on breath acetone measurements.

    Science.gov (United States)

    Wang, Zhennan; Wang, Chuji

    2013-09-01

    Since the ancient discovery of the 'sweet odor' in human breath gas, pursuits of the breath analysis-based disease diagnostics have never stopped. Actually, the 'smell' of the breath, as one of three key disease diagnostic techniques, has been used in Eastern-Medicine for more than three thousand years. With advancement of measuring technologies in sensitivity and selectivity, more specific breath gas species have been identified and established as a biomarker of a particular disease. Acetone is one of the breath gases and its concentration in exhaled breath can now be determined with high accuracy using various techniques and methods. With the worldwide prevalence of diabetes that is typically diagnosed through blood testing, human desire to achieve non-blood based diabetic diagnostics and monitoring has never been quenched. Questions, such as is breath acetone a biomarker of diabetes and how is the breath acetone related to the blood glucose (BG) level (the golden criterion currently used in clinic for diabetes diagnostic, monitoring, and management), remain to be answered. A majority of current research efforts in breath acetone measurements and its technology developments focus on addressing the first question. The effort to tackle the second question has begun recently. The earliest breath acetone measurement in clearly defined diabetic patients was reported more than 60 years ago. For more than a half-century, as reviewed in this paper, there have been more than 41 independent studies of breath acetone using various techniques and methods, and more than 3211 human subjects, including 1581 healthy people, 242 Type 1 diabetic patients, 384 Type 2 diabetic patients, 174 unspecified diabetic patients, and 830 non-diabetic patients or healthy subjects who are under various physiological conditions, have been used in the studies. The results of the breath acetone measurements collected in this review support that many conditions might cause changes to breath

  13. Noninvasive work of breathing improves prediction of post-extubation outcome.

    Science.gov (United States)

    Banner, Michael J; Euliano, Neil R; Martin, A Daniel; Al-Rawas, Nawar; Layon, A Joseph; Gabrielli, Andrea

    2012-02-01

    We hypothesized that non-invasively determined work of breathing per minute (WOB(N)/min) (esophageal balloon not required) may be useful for predicting extubation outcome, i.e., appropriate work of breathing values may be associated with extubation success, while inappropriately increased values may be associated with failure. Adult candidates for extubation were divided into a training set (n = 38) to determine threshold values of indices for assessing extubation and a prospective validation set (n = 59) to determine the predictive power of the threshold values for patients successfully extubated and those who failed extubation. All were evaluated for extubation during a spontaneous breathing trial (5 cmH(2)O pressure support ventilation, 5 cmH(2)O positive end expiratory pressure) using routine clinical practice standards. WOB(N)/min data were blinded to attending physicians. Area under the receiver operating characteristic curves (AUC), sensitivity, specificity, and positive and negative predictive values of all extubation indices were determined. AUC for WOB(N)/min was 0.96 and significantly greater (p indices. WOB(N)/min had a specificity of 0.83, the highest sensitivity at 0.96, positive predictive value at 0.84, and negative predictive value at 0.96 compared to all indices. For 95% of those successfully extubated, WOB(N)/min was ≤10 J/min. WOB(N)/min had the greatest overall predictive accuracy for extubation compared to traditional indices. WOB(N)/min warrants consideration for use in a complementary manner with spontaneous breathing pattern data for predicting extubation outcome.

  14. A mass balance model for the Mapleson D anaesthesia breathing system.

    Science.gov (United States)

    Lovich, M A; Simon, B A; Venegas, J G; Sims, N M; Cooper, J B

    1993-06-01

    A mathematical model is described which calculates the alveolar concentration of CO2(FACO2) in a patient breathing through a Mapleson D anaesthesia system. The model is derived using a series of mass balances for CO2 in the alveolar space, dead space, breathing system limb volume and reservoir. The variables included in the model are tidal volume (VT), respiratory rate, fresh gas flow rate (Vf), dead space volume, I:E ratio, and expiratory limb volume (Vl) time constant of lung expiration, and carbon dioxide production rate. The model predictions are compared with measurements made using a mechanical lung simulator in both spontaneous and controlled ventilation. Both the model and the experimental data predict that at high fresh gas flow rates and low respiratory rates, FACO2 is independent of Vf; at low fresh gas flow rates and high respiratory rates, FACO2 is independent of respiratory rate. The model and the data show that the VT influences FACO2, independent of minute ventilation alone, during both partial re-breathing and non-rebreathing operation. Therefore, describing the operation in terms of minute ventilation is ambiguous. It is also shown that Vl influences FACO2 such that, for any combination of patient and breathing-system variables, there is a Vl that minimizes the Vf required to maintain FACO2. In addition, expiratory resistance can increase the fresh gas flow rate required to maintain a given FACO2. The respiratory patterns observed with spontaneous and controlled ventilation are responsible for the difference in Vf required with each mode of ventilation.

  15. Anaesthetic Management of a patient with Myasthenia Gravis and Small Bowel Intussusception for Jejuno-Ileal Anastomoses

    Directory of Open Access Journals (Sweden)

    Pawan Kumar Jain

    2016-01-01

    Full Text Available Myasthenia gravis is a chronic autoimmune disease affecting voluntary skeletal muscles. The altered sensitivity of acetylcholine receptors to muscle relaxants and concomitant treatment with anticholinesterase in these patients affect their anaesthetic management. Patients who have undergone bowel anastomosis and are on regular anticholinesterase treatment are susceptible to anastomotic leaks. We report successful anaesthetic management of class I myasthenic patient with coexisting small bowel intussusception operated for jejuno-ileal anastomoses using regional, inhalational and intravenous (i.v anaesthesia based on train of four responses, and avoiding the use of reversal (anticholinesterase.

  16. 42 CFR 84.141 - Breathing gas; minimum requirements.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing gas; minimum requirements. 84.141 Section... Respirators § 84.141 Breathing gas; minimum requirements. (a) Breathing gas used to supply supplied-air respirators shall be respirable breathing air and contain no less than 19.5 volume-percent of oxygen. (b...

  17. 14 CFR 25.1439 - Protective breathing equipment.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Protective breathing equipment. 25.1439... Protective breathing equipment. (a) Fixed (stationary, or built in) protective breathing equipment must be installed for the use of the flightcrew, and at least one portable protective breathing equipment shall be...

  18. 42 CFR 84.90 - Breathing resistance test; inhalation.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing resistance test; inhalation. 84.90...-Contained Breathing Apparatus § 84.90 Breathing resistance test; inhalation. (a) Resistance to inhalation airflow will be measured in the facepiece or mouthpiece while the apparatus is operated by a breathing...

  19. 42 CFR 84.91 - Breathing resistance test; exhalation.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing resistance test; exhalation. 84.91...-Contained Breathing Apparatus § 84.91 Breathing resistance test; exhalation. (a) Resistance to exhalation...-circuit apparatus with a breathing machine as described in § 84.88, and the exhalation resistance shall...

  20. 42 CFR 84.88 - Breathing bag test.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Breathing bag test. 84.88 Section 84.88 Public... RESEARCH AND RELATED ACTIVITIES APPROVAL OF RESPIRATORY PROTECTIVE DEVICES Self-Contained Breathing Apparatus § 84.88 Breathing bag test. (a) Breathing bags will be tested in an air atmosphere saturated with...

  1. 14 CFR 121.337 - Protective breathing equipment.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Protective breathing equipment. 121.337... Protective breathing equipment. (a) The certificate holder shall furnish approved protective breathing equipment (PBE) meeting the equipment, breathing gas, and communication requirements contained in paragraph...

  2. 21 CFR 868.5270 - Breathing system heater.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Breathing system heater. 868.5270 Section 868.5270...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5270 Breathing system heater. (a) Identification. A breathing system heater is a device that is intended to warm breathing gases before they enter...

  3. Spontaneous intraorbital hematoma: case report

    Directory of Open Access Journals (Sweden)

    Vinodan Paramanathan

    2010-12-01

    Full Text Available Vinodan Paramanathan, Ardalan ZolnourianQueen's Hospital NHS Foundation Trust, Burton on Trent, Staffordshire DE13 0RB, UKAbstract: Spontaneous intraorbital hematoma is an uncommon clinical entity seen in ophthalmology practice. It is poorly represented in the literature. Current evidence attributes it to orbital trauma, neoplasm, vascular malformations, acute sinusitis, and systemic abnormalities. A 65-year-old female presented with spontaneous intraorbital hematoma manifesting as severe ocular pains, eyelid edema, proptosis, and diplopia, without a history of trauma. Computer tomography demonstrated a fairly well defined extraconal lesion with opacification of the paranasal sinuses. The principal differential based on all findings was that of a spreading sinus infection and an extraconal tumor. An unprecedented finding of a spontaneous orbital hematoma was discovered when the patient was taken to theater. We discuss the rarity of this condition and its management.Keywords: hemorrhage, ophthalmology, spontaneous, intra-orbital, hematoma

  4. [Anaesthetic management in a paediatric patient with a difficult airway due to epidermolysis bullosa dystrophica].

    Science.gov (United States)

    Blázquez Gómez, E; Garcés Aletá, A; Monclus Diaz, E; Manen Berga, F; García-Aparicio, L; Ontanilla López, A

    2015-05-01

    Dystrophic epidermolysis bullosa (DEB) is a rare inherited disorder characterized by blistering after minimal trauma. These blisters tend to form dystrophic scars, leading to limiting and life-threatening sequelae. The anaesthetic management of patients with DEB is a challenge, even for the most experienced anaesthesiologists, but basic principles can help us prepare the plan of care. The main goals are to prevent trauma/infection of skin/mucous, and to establish a secure airway without causing bullae. Patient positioning and the instruments used to monitor vital signs and administering anaesthetic agents can cause new lesions. It is advisable to lubricate the instruments and to avoid adhesive material and shearing forces on the skin. Besides the implications of the comorbidities, there is a potential difficult intubation and difficult vascular access. Acute airway obstruction can occur due to airway instrumentation. We report the case of a patient diagnosed with EBD difficult airway and undergoing correction of syndactylyl and dental extractions. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Drug distribution in spinal cord during administration with spinal loop dialysis probes in anaesthetized rats

    DEFF Research Database (Denmark)

    Uustalu, Maria; Abelson, Klas S P

    2007-01-01

    The present investigation aimed to study two methodological concerns of an experimental model, where a spinal loop dialysis probe is used for administration of substances to the spinal cord and sampling of neurotransmitters by microdialysis from the same area of anaesthetized rats. [(3)H]Epibatid......The present investigation aimed to study two methodological concerns of an experimental model, where a spinal loop dialysis probe is used for administration of substances to the spinal cord and sampling of neurotransmitters by microdialysis from the same area of anaesthetized rats. [(3)H......]Epibatidine in concentrations of 1, 10 and 100 nM was dissolved in Ringer's solution and administered through the dialysis membrane into the dorsal region of the cervical spinal cord. First, the outflow of [(3)H]epibatidine from the probe into the spinal cord was examined with respect to different concentrations and changes....... The administered [(3)H]epibatidine was found to be distributed to the area closest to the dialysis probe and not dispersed along the spinal cord, and the distribution was equal for all concentrations. The data presented in this investigation provide information, which is important for interpretation of data from...

  6. Robotic invasion of operation theatre and associated anaesthetic issues: A review

    Directory of Open Access Journals (Sweden)

    Prem N Kakar

    2011-01-01

    Full Text Available A Robotic device is a powered, computer controlled manipulator with artificial sensing that can be reprogrammed to move and position tools to carry out a wide range of tasks. Robots and Telemanipulators were first developed by the National Aeronautics and Space Administration (NASA for use in space exploration. Today′s medical robotic systems were the brainchild of the United States Department of Defence′s desire to decrease war casualties with the development of ′telerobotic surgery′. The ′master-slave′ telemanipulator concept was developed for medical use in the early 1990s where the surgeon′s (master manual movements were transmitted to end-effector (slave instruments at a remote site. Since then, the field of surgical robotics has undergone massive transformation and the future is even brighter. As expected, any new technique brings with it risks and the possibility of technical difficulties. The person who bears the brunt of complications or benefit from a new invention is the ′Patient′. Anaesthesiologists as always must do their part to be the patient′s ′best man′ in the perioperative period. We should be prepared for screening and selection of patients in a different perspective keeping in mind the steep learning curves of surgeons, long surgical hours, extreme patient positioning and other previously unknown anaesthetic challenges brought about by the surgical robot. In this article we have tried to track the development of surgical robots and consider the unique anaesthetic issues related to robot assisted surgeries.

  7. Meningomyelocele Repair in a Premature Newborn with Hydrocephalus: Anaesthetic Confronts and Management

    Directory of Open Access Journals (Sweden)

    Sandhya Ghodke

    2017-07-01

    Full Text Available Deficit of neural tube closure in the initial phases of intrauterine development leads to a gamut of abnormalities ranging from spina-bifida occulta, a relatively benign condition, to encephalocele and meningomyelocele, an anomaly in vertebral bodies, spinal cord and sometimes involving brainstem (in cervical meningomyelocele. Meningomyelocele is the most common nonlethal malformation in the spectrum of neural tube deficits. The intrinsic challenges associated with the latter disorder warrants tailor-made approaches for providing anaesthesia to the requisite therapeutic surgical interventions. Pediatric patients pose a set of natural barriers because of their ever budding and maturing neurophysiological status, apart from the central neural disease process. Hence, in order to provide optimal neuro-anaesthetic care, the anaesthesiologist must have the knowledge of the outcomes of various pharmacologic interventions on cerebral aerodynamics apart from his professional experience in pediatric neuroanaesthesia. The current case report accounts for a challenging anaesthetic management in a premature newborn having hydrocephalus and lumbosacral meningomyelocele, presented for surgical repair within four hours of delivery.

  8. Analysis for drugs in saliva and breath

    Science.gov (United States)

    1981-09-25

    Collection devices for saliva and breath that involved non-invasive techniques for sample collection were evaluated. Having subjects simply spit into a specially prepared glass vial was found to be an efficient, inexpensive and simple way to collect ...

  9. Analysis for drug in saliva and breath

    Science.gov (United States)

    1981-09-25

    Collection devices for saliva and breath that involved non-invasive : techniques for sample collection were evaluated. Having subjects simply : spit into a specially prepared glass vial was found to be an efficient, : inexpensive and simple way to co...

  10. Healthy Living: Helping Your Child Breathe Easier

    Science.gov (United States)

    ... Breathe Easier Font: Aerosol Delivery Oxygen Resources Immunizations Pollution Nutrition Exercise Coming Of Age Older Adults Allergy ... through these narrowed airways can produce a wheezing sound. Other forms the allergy may take are sneezing, ...

  11. Breath-holding spells in infants.

    Science.gov (United States)

    Goldman, Ran D

    2015-02-01

    I have children in my clinic who experience seizurelike episodes in which they cry and hold their breath to the point of cyanosis and loss of consciousness. Their examination or investigation findings are normal and referral to a pediatric specialist results in no further investigation. Are breath-holding spells common, and what type of investigation is needed? A breath-holding spell is a benign paroxysmal nonepileptic disorder occurring in healthy children 6 to 48 months of age. The episodes start with a provocation such as emotional upset or minor injury, and might progress to breath holding, cyanosis, and syncope. The episodes are extremely frightening to watch but have benign consequences. Once a clinical diagnosis is made, it is recommended to conduct an electrocardiogram and to rule out anemia, but no further investigation or referral is warranted. Copyright© the College of Family Physicians of Canada.

  12. Humidifiers: Air Moisture Eases Skin, Breathing Symptoms

    Science.gov (United States)

    Humidifiers: Air moisture eases skin, breathing symptoms Humidifiers can ease problems caused by dry air. But they need regular maintenance. Here ... that emit water vapor or steam to increase moisture levels in the air (humidity). There are several ...

  13. Alcohol breath test: gas exchange issues.

    Science.gov (United States)

    Hlastala, Michael P; Anderson, Joseph C

    2016-08-01

    The alcohol breath test is reviewed with a focus on gas exchange factors affecting its accuracy. The basis of the alcohol breath test is the assumption that alveolar air reaches the mouth during exhalation with no change in alcohol concentration. Recent investigations have shown that alcohol concentration is altered during its transit to the mouth. The exhaled alcohol concentration is modified by interaction with the mucosa of the pulmonary airways. Exhaled alcohol concentration is not an accurate indicator of alveolar alcohol concentration. Measuring alcohol concentration in the breath is very different process than measuring a blood level from air equilibrated with a blood sample. Airway exchange of alcohol leads to a bias against certain individuals depending on the anatomic and physiologic characteristics. Methodological modifications are proposed to improve the accuracy of the alcohol breath test to become fair to all. Copyright © 2016 the American Physiological Society.

  14. Seeking Allergy Relief: When Breathing Becomes Bothersome

    Science.gov (United States)

    ... Issues Subscribe June 2016 Print this issue Seeking Allergy Relief When Breathing Becomes Bothersome En español Send ... Preschoolers Benefit from Peanut Allergy Therapy Wise Choices Allergy Symptoms Runny or stuffy nose Sneezing Itchy nose, ...

  15. Atmospheric Breathing Electric Thruster for Planetary Exploration

    Data.gov (United States)

    National Aeronautics and Space Administration — This study will investigate the development of an atmosphere-breathing electric propulsion solar-powered vehicle to explore planets such as Mars. The vehicle would...

  16. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  17. Spontaneity and international marketing performance

    OpenAIRE

    Souchon, Anne L.; Hughes, Paul; Farrell, Andrew M.; Nemkova, Ekaterina; Oliveira, Joao S.

    2016-01-01

    The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. Purpose – The purpose of this paper is to ascertain how today’s international marketers can perform better on the global scene by harnessing spontaneity. Design/methodology/approach – The authors draw on contingency theory to develop a model of the spontaneity – international marketing performance relationship, and identify three potential m...

  18. Bicuculline, pentobarbital and diazepam modulate spontaneous GABAA channels in rat hippocampal neurons

    Science.gov (United States)

    Birnir, Bryndis; Eghbali, Mansoureh; Everitt, Andrea B; Gage, Peter W

    2000-01-01

    Spontaneously opening, chloride-selective channels that showed outward rectification were recorded in ripped-off patches from rat cultured hippocampal neurons and in cell-attached patches from rat hippocampal CA1 pyramidal neurons in slices. In both preparations, channels had multiple conductance states and the most common single-channel conductance varied. In the outside-out patches it ranged from 12 to 70 pS (Vp=40 mV) whereas in the cell-attached patches it ranged from 56 to 85 pS (−Vp=80 mV). Application of GABA to a patch showing spontaneous channel activity evoked a rapid, synchronous activation of channels. During prolonged exposure to either 5 or 100 μM GABA, the open probability of channels decreased. Application of GABA appeared to have no immediate effect on single-channel conductance. Exposure of the patches to 100 μM bicuculline caused a gradual decrease on the single-channel conductance of the spontaneous channels. The time for complete inhibition to take place was slower in the outside-out than in the cell-attached patches. Application of 100 μM pentobarbital or 1 μM diazepam caused 2–4 fold increase in the maximum channel conductance of low conductance (<40 pS) spontaneously active channels. The observation of spontaneously opening GABAA channels in cell-attached patches on neurons in slices suggests that they may have a role in neurons in vivo and could be an important site of action for some drugs such as benzodiazepines, barbiturates and general anaesthetics. PMID:11030718

  19. Long-term monitoring of breath methane.

    Science.gov (United States)

    Polag, Daniela; Keppler, Frank

    2018-05-15

    In recent years, methane as a component of exhaled human breath has been considered as a potential bioindicator providing information on microbial activity in the intestinal tract. Several studies indicated a relationship between breath methane status and specific gastrointestinal disease. So far, almost no attention has been given to the temporal variability of breath methane production by individual persons. Thus here, for the first time, long-term monitoring was carried out measuring breath methane of three volunteers over periods between 196 and 1002days. Results were evaluated taking into consideration the health status and specific medical intervention events for each individual during the monitoring period, and included a gastroscopy procedure, a vaccination, a dietary change, and chelate therapy. As a major outcome, breath methane mixing ratios show considerable variability within a person-specific range of values. Interestingly, decreased breath methane production often coincided with gastrointestinal complaints whereas influenza infections were mostly accompanied by increased breath methane production. A gastroscopic examination as well as a change to a low-fructose diet led to a dramatic shift of methane mixing ratios from high to low methane production. In contrast, a typhus vaccination as well as single chelate injections resulted in significant short-term methane peaks. Thus, this study clearly shows that humans can change from high to low methane emitters and vice versa within relatively short time periods. In the case of low to medium methane emitters the increase observed in methane mixing ratios, likely resulting from immune reactions and inflammatory processes, might indicate non-microbial methane formation under aerobic conditions. Although detailed reaction pathways are not yet known, aerobic methane formation might be related to cellular oxidative-reductive stress reactions. However, a detailed understanding of the pathways involved in human

  20. Swimming in air-breathing fishes.

    Science.gov (United States)

    Lefevre, S; Domenici, P; McKenzie, D J

    2014-03-01

    Fishes with bimodal respiration differ in the extent of their reliance on air breathing to support aerobic metabolism, which is reflected in their lifestyles and ecologies. Many freshwater species undertake seasonal and reproductive migrations that presumably involve sustained aerobic exercise. In the six species studied to date, aerobic exercise in swim flumes stimulated air-breathing behaviour, and there is evidence that surfacing frequency and oxygen uptake from air show an exponential increase with increasing swimming speed. In some species, this was associated with an increase in the proportion of aerobic metabolism met by aerial respiration, while in others the proportion remained relatively constant. The ecological significance of anaerobic swimming activities, such as sprinting and fast-start manoeuvres during predator-prey interactions, has been little studied in air-breathing fishes. Some species practise air breathing during recovery itself, while others prefer to increase aquatic respiration, possibly to promote branchial ion exchange to restore acid-base balance, and to remain quiescent and avoid being visible to predators. Overall, the diversity of air-breathing fishes is reflected in their swimming physiology as well, and further research is needed to increase the understanding of the differences and the mechanisms through which air breathing is controlled and used during exercise. © 2014 The Fisheries Society of the British Isles.

  1. Periodic breathing and apnea in preterm infants.

    Science.gov (United States)

    Barrington, K J; Finer, N N

    1990-02-01

    The relationship between periodic breathing and idiopathic apnea of prematurity was investigated. We recorded respiratory impedance, heart rate, pulse oximetry and end-tidal CO2 from 68 untreated infants of less than or equal to 34 wk gestation with a diagnosis of idiopathic apnea of prematurity. Mean birth wt was 1476 g (SD 420) and mean gestational age was 29.9 wk (SD 2.6). Apneas of more than 15 s duration that were associated with hypoxemia or bradycardia were identified by semiautomated analysis of computerized records. A total of 1116 significant apneic spells were identified, only one of which occurred during an epoch of periodic breathing, five others occurred within 2 min of the end of an epoch of periodic breathing. Less than 0.6% of significant apneic spells occur within 2 min of periodic breathing. In all of the 12 infants that were monitored starting in the first 12 h of life, significant apneic spells were identified before 36 h of age and no precipitating factors were identified. Periodic breathing did not occur during the first 48 h of life, a finding that supports the concept that the peripheral chemoreceptor is inactive in the first 48 h of life. Periodic breathing in the premature infant is not a precursor to significant apnea.

  2. Optoacoustic 13C-breath test analyzer

    Science.gov (United States)

    Harde, Hermann; Helmrich, Günther; Wolff, Marcus

    2010-02-01

    The composition and concentration of exhaled volatile gases reflects the physical ability of a patient. Therefore, a breath analysis allows to recognize an infectious disease in an organ or even to identify a tumor. One of the most prominent breath tests is the 13C-urea-breath test, applied to ascertain the presence of the bacterium helicobacter pylori in the stomach wall as an indication of a gastric ulcer. In this contribution we present a new optical analyzer that employs a compact and simple set-up based on photoacoustic spectroscopy. It consists of two identical photoacoustic cells containing two breath samples, one taken before and one after capturing an isotope-marked substrate, where the most common isotope 12C is replaced to a large extent by 13C. The analyzer measures simultaneously the relative CO2 isotopologue concentrations in both samples by exciting the molecules on specially selected absorption lines with a semiconductor laser operating at a wavelength of 2.744 μm. For a reliable diagnosis changes of the 13CO2 concentration of 1% in the exhaled breath have to be detected at a concentration level of this isotope in the breath of about 500 ppm.

  3. Effect of Continuous Promedol Infusion on Recovery of Spontaneous Breathing in Children in the Postoperative Period

    Directory of Open Access Journals (Sweden)

    E. V. Zilbert

    2011-01-01

    Full Text Available Objective: to study the impact of correcting immune disorders on the course of the disease in patients with abdominal sepsis. Subjects and methods. Ninety-five patients with abdominal sepsis were examined. APACHE III scores were 25—30. Humoral and cellular immunological parameters were studied in all the patients. The immunotropic drug Galavit was included into the combination treatment of 42 patients. Results. An immunodeficiency state was found in 74 (80% patients. The incorporation of targeted immunotherapy into the package of medical measures activated the immune system of patients and, in a number of cases, could elevate the level of T lymphocytes, reduced the rate of laparostomy wound suppurations by 1.9 times and the number of fatal outcomes by 10.1%. Conclusion. Incorporation of targeted immunotherapy into the package of medical measures activates cellular immunity and tissue regeneration processes and reduces the degree of endogenous intoxication, the rate of laparostomy wound suppurations, and the number of fatal outcomes. Key words: abdominal sepsis, immunomodulation, Galavit.

  4. [Weaning from prolonged mechanical ventilation at 72 hours of spontaneous breathing].

    Science.gov (United States)

    Villalba, Darío; Plotnikow, Gustavo; Feld, Viviana; Rivero Vairo, Noelia; Scapellato, José; Díaz Nielsen, Ernesto

    2015-01-01

    The aim of this study was to describe the population admitted to a weaning center (WC) to receive invasive mechanical ventilation (MV), analyze their evolution and identify weaning failure predictors. The medical records of 763 patients admitted to the respiratory care service in the period between May 2005 and January 2012 were reviewed; 372 were selected among 415 tracheotomized and mechanically ventilated. Different variables were analyzed as weaning failure predictors. The mean age of patients admitted was 69 years (SD 14.7), 57% were men. The median length of hospitalization in ICU was 33 days (IQR 26-46). Admission to ICU was due to medical causes in 86% of cases. During hospitalization in WC 186 (50%) patients achieved the successful weaning at a median of 13 days (interquartile range-IQR 5-38). A predictor of weaning failure was age. When we studied the subpopulation with partial disconnection of mechanical ventilation, we found a history of COPD and ageas predictors. Although 25% of the patients died, or required referral to a center of major complexity before 2 weeks of hospitalization, more than half of the patients were able to be removed permanently from the invasive mechanical ventilation (MV), this could support the care of chronic critical patients in MV and rehabilitation centers in Argentina because patients in these centers have a chance of weaning from MV, despite the high chances of developing complications.

  5. The Influence of the Thymine C5 Methyl Group on Spontaneous Base Pair Breathing in DNA

    Czech Academy of Sciences Publication Activity Database

    Wärmländer, S.; Šponer, Jiří; Leijon, M.; Šponer, Judit E.

    2002-01-01

    Roč. 277, č. 32 (2002), s. 28491-28497 ISSN 0021-9258 R&D Projects: GA MŠk LN00A016 Institutional research plan: CEZ:AV0Z4040901 Keywords : thymine * DNA * base pairs Subject RIV: CF - Physical ; Theoretical Chemistry Impact factor: 6.696, year: 2002

  6. In vivo proton MRS of normal pancreas metabolites during breath-holding and free-breathing

    International Nuclear Information System (INIS)

    Su, T.-H.; Jin, E.-H.; Shen, H.; Zhang, Y.; He, W.

    2012-01-01

    Aim: To characterize normal pancreas metabolites using in vivo proton magnetic resonance spectroscopy ( 1 H MRS) at 3 T under conditions of breath-holding and free-breathing. Materials and methods: The pancreases of 32 healthy volunteers were examined using 1 H MRS during breath-holding and free-breathing acquisitions in a single-voxel point-resolved selective spectroscopy sequence (PRESS) technique using a 3 T MRI system. Resonances were compared between paired spectra of the two breathing modes. Furthermore, correlations between lipid (Lip) content and age, body-mass index (BMI), as well as choline (Cho) peak visibility of the normal pancreas were analysed during breath-holding. Results: Twenty-nine pairs of spectra were successfully obtained showing three major resonances, Lip, Cho, cholesterol and the unsaturated parts of the olefinic region of fatty acids (Chol + Unsat). Breath-hold spectra were generally better, with higher signal-to-noise ratios (SNR; Z=–2.646, p = 0.008) and Cho peak visible status (Z=–2.449, p = 0.014). Correlations were significant between spectra acquired by the two breathing modes, especially for Lip height, Lip area, and the area of other peaks at 1.9–4.1 ppm. However, the Lip resonance was significantly different between the spectra of the two breathing modes (p 1 H MRS of the normal pancreas at 3 T is technically feasible and can characterize several metabolites. 1 H MRS during breath-holding acquisition is superior to that during free-breathing acquisition.

  7. Role of parafacial nuclei in control of breathing in adult rats.

    Science.gov (United States)

    Huckstepp, Robert T R; Cardoza, Kathryn P; Henderson, Lauren E; Feldman, Jack L

    2015-01-21

    Contiguous brain regions associated with a given behavior are increasingly being divided into subregions associated with distinct aspects of that behavior. Using recently developed neuronal hyperpolarizing technologies, we functionally dissect the parafacial region in the medulla, which contains key elements of the central pattern generator for breathing that are important in central CO2-chemoreception and for gating active expiration. By transfecting different populations of neighboring neurons with allatostatin or HM4D Gi/o-coupled receptors, we analyzed the effect of their hyperpolarization on respiration in spontaneously breathing vagotomized urethane-anesthetized rats. We identify two functionally separate parafacial nuclei: ventral (pFV) and lateral (pFL). Disinhibition of the pFL with bicuculline and strychnine led to active expiration. Hyperpolarizing pFL neurons had no effect on breathing at rest, or changes in inspiratory activity induced by hypoxia and hypercapnia; however, hyperpolarizing pFL neurons attenuated active expiration when it was induced by hypercapnia, hypoxia, or disinhibition of the pFL. In contrast, hyperpolarizing pFV neurons affected breathing at rest by decreasing inspiratory-related activity, attenuating the hypoxia- and hypercapnia-induced increase in inspiratory activity, and when present, reducing expiratory-related abdominal activity. Together with previous observations, we conclude that the pFV provides a generic excitatory drive to breathe, even at rest, whereas the pFL is a conditional oscillator quiet at rest that, when activated, e.g., during exercise, drives active expiration. Copyright © 2015 the authors 0270-6474/15/351052-16$15.00/0.

  8. A New Anaesthetic Protocol for Adult Zebrafish (Danio rerio: Propofol Combined with Lidocaine.

    Directory of Open Access Journals (Sweden)

    Ana M Valentim

    Full Text Available The increasing use of zebrafish model has not been accompanied by the evolution of proper anaesthesia for this species in research. The most used anaesthetic in fishes, MS222, may induce aversion, reduction of heart rate, and consequently high mortality, especially during long exposures. Therefore, we aim to explore new anaesthetic protocols to be used in zebrafish by studying the quality of anaesthesia and recovery induced by different concentrations of propofol alone and in combination with different concentrations of lidocaine.In experiment A, eighty-three AB zebrafish were randomly assigned to 7 different groups: control, 2.5 (2.5P, 5 (5P or 7.5 μg/ml (7.5P of propofol; and 2.5 μg/ml of propofol combined with 50, (P/50L, 100 (P/100L or 150 μg/ml (P/150L of lidocaine. Zebrafish were placed in an anaesthetic water bath and time to lose the equilibrium, reflex to touch, reflex to a tail pinch, and respiratory rate were measured. Time to gain equilibrium was also assessed in a clean tank. Five and 24 hours after anaesthesia recovery, zebrafish were evaluated concerning activity and reactivity. Afterwards, in a second phase of experiments (experiment B, the best protocol of the experiment A was compared with a new group of 8 fishes treated with 100 mg/L of MS222 (100M.In experiment A, only different concentrations of propofol/lidocaine combination induced full anaesthesia in all animals. Thus only these groups were compared with a standard dose of MS222 in experiment B. Propofol/lidocaine induced a quicker loss of equilibrium, and loss of response to light and painful stimuli compared with MS222. However zebrafish treated with MS222 recovered quickly than the ones treated with propofol/lidocaine.In conclusion, propofol/lidocaine combination and MS222 have advantages in different situations. MS222 is ideal for minor procedures when a quick recovery is important, while propofol/lidocaine is best to induce a quick and complete anaesthesia.

  9. Chemical sensors for breath gas analysis: the latest developments at the Breath Analysis Summit 2013.

    Science.gov (United States)

    Tisch, Ulrike; Haick, Hossam

    2014-06-01

    Profiling the body chemistry by means of volatile organic compounds (VOCs) in the breath opens exciting new avenues in medical diagnostics. Gas sensors could provide ideal platforms for realizing portable, hand-held breath testing devices in the near future. This review summarizes the latest developments and applications in the field of chemical sensors for diagnostic breath testing that were presented at the Breath Analysis Summit 2013 in Wallerfangen, Germany. Considerable progress has been made towards clinically applicable breath testing devices, especially by utilizing chemo-sensitive nanomaterials. Examples of several specialized breath testing applications are presented that are either based on stand-alone nanomaterial-based sensors being highly sensitive and specific to individual breath compounds over others, or on combinations of several highly specific sensors, or on experimental nanomaterial-based sensors arrays. Other interesting approaches include the adaption of a commercially available MOx-based sensor array to indirect breath testing applications, using a sample pre-concentration method, and the development of compact integrated GC-sensor systems. The recent trend towards device integration has led to the development of fully integrated prototypes of point-of-care devices. We describe and compare the performance of several prototypes that are based on different sensing technologies and evaluate their potential as low-cost and readily available next-generation medical devices.

  10. A case of spontaneous ventriculocisternostomy

    International Nuclear Information System (INIS)

    Yamane, Kanji; Yoshimoto, Hisanori; Harada, Kiyoshi; Uozumi, Tohru; Kuwabara, Satoshi.

    1983-01-01

    The authors experienced a case of spontaneous ventriculocisternostomy diagnosed by CT scan with metrizamide and Conray. Patient was 23-year-old male who had been in good health until one month before admission, when he began to have headache and tinnitus. He noticed bilateral visual acuity was decreased about one week before admission and vomiting appeared two days before admission. He was admitted to our hospital because of bilateral papilledema and remarkable hydrocephalus diagnosed by CT scan. On admission, no abnormal neurological signs except for bilateral papilledema were noted. Immediately, right ventricular drainage was performed. Pressure of the ventricle was over 300mmH 2 O and CSF was clear. PVG and PEG disclosed an another cavity behind the third ventricle, which was communicated with the third ventricle, and occlusion of aqueduct of Sylvius. Metrizamide CT scan and Conray CT scan showed a communication between this cavity and quadrigeminal and supracerebellar cisterns. On these neuroradiological findings, the diagnosis of obstructive hydrocephalus due to benign aqueduct stenosis accompanied with spontaneous ventriculocisternostomy was obtained. Spontaneous ventriculocisternostomy was noticed to produce arrest of hydrocephalus, but with our case, spontaneous regression of such symptoms did not appeared. By surgical ventriculocisternostomy (method by Torkildsen, Dandy, or Scarff), arrest of hydrocephalus was seen in about 50 to 70 per cent, which was the same results as those of spontaneous ventriculocisternostomy. It is concluded that VP shunt or VA shunt is thought to be better treatment of obstructive hydrocephalus than the various kinds of surgical ventriculocisternostomy. (J.P.N.)

  11. Optical antenna enhanced spontaneous emission.

    Science.gov (United States)

    Eggleston, Michael S; Messer, Kevin; Zhang, Liming; Yablonovitch, Eli; Wu, Ming C

    2015-02-10

    Atoms and molecules are too small to act as efficient antennas for their own emission wavelengths. By providing an external optical antenna, the balance can be shifted; spontaneous emission could become faster than stimulated emission, which is handicapped by practically achievable pump intensities. In our experiments, InGaAsP nanorods emitting at ∼ 200 THz optical frequency show a spontaneous emission intensity enhancement of 35 × corresponding to a spontaneous emission rate speedup ∼ 115 ×, for antenna gap spacing, d = 40 nm. Classical antenna theory predicts ∼ 2,500 × spontaneous emission speedup at d ∼ 10 nm, proportional to 1/d(2). Unfortunately, at d antenna efficiency drops below 50%, owing to optical spreading resistance, exacerbated by the anomalous skin effect (electron surface collisions). Quantum dipole oscillations in the emitter excited state produce an optical ac equivalent circuit current, I(o) = qω|x(o)|/d, feeding the antenna-enhanced spontaneous emission, where q|x(o)| is the dipole matrix element. Despite the quantum-mechanical origin of the drive current, antenna theory makes no reference to the Purcell effect nor to local density of states models. Moreover, plasmonic effects are minor at 200 THz, producing only a small shift of antenna resonance frequency.

  12. An audit of the use of an opiate sparing, multimodal analgesic regime in children with Sleep Disordered Breathing/Obstructive Sleep Apnoea undergoing adenotonsillectomy.

    Science.gov (United States)

    Hack, Henrik

    2014-01-01

    Children with Sleep Disordered Breathing/Obstructive Sleep Apnoea have an increased incidence of respiratory complications following adenotonsillectomy. This may be partly related to an increase in sensitivity to opiates. An audit of such cases undergoing adenotonsillectomy was performed with the following aims: All patients had Sleep Disordered Breathing/Obstructive Sleep Apnoea confirmed preoperatively by Overnight Oximetry Studies. Oximetry data was expressed as the lowest recorded saturation (SpO2 Low %) and number of significant desaturations (see text) per hour (ODI4%). Case notes and oximetry studies were scrutinized for relevant perioperative anaesthetic and analgesic data, risk factors and complications. The overall incidence of major and minor respiratory complications was low (1.6% and 27% respectively). Children who suffered any complication were more likely to be younger (p=0.0078), have a lower SpO2 Low (p=0.004) and higher ODI4% (p=8 may be the best cut off point in predicting complications (AUC=0.78, sensitivity=0.90) but it showed a poor specificity (0.57). Primary/secondary haemorrhage occurred in 0.4%/1.2% respectively and postoperative nausea and vomiting in 4.4%. A low dose opiate-based, multi modal analgesic regime appears to be effective and safe in children with Sleep Disordered Breathing/Obstructive Sleep Apnoea undergoing adenotonsillectomy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  13. Spontaneous baroreflex by sequence and power spectral methods in humans.

    Science.gov (United States)

    Hughson, R L; Quintin, L; Annat, G; Yamamoto, Y; Gharib, C

    1993-11-01

    Beat-by-beat variations in blood pressure and RR-interval are interrelated by the actions of baroreflex and non-baroreflex responses. This study had two purposes: (1) to examine the spontaneous relationships between RR-interval and systolic blood pressure to determine the relative occurrence of baroreflex and non-baroreflex responses in humans, and (2) to compare the beat-sequence method with a cross spectral estimate of the baroreflex response slope. Eight healthy men were studied during 10 h of quiet, seated rest, and six men and three women were studied during rest, rest plus fixed pace breathing, and a cold pressor test. RR-interval and continuous, non-invasive arterial blood pressure were measured with a computerized system. A baroreflex sequence was defined by a series of at least three consecutive heart beats in which systolic pressure and the following RR-interval either both increased or both decreased. A non-baroreflex relationship was defined by sequences of at least three beats by opposite directional changes of RR-interval and systolic pressure of that beat. The results showed that there were approximately 30% as many non-baroreflex compared to baroreflex slopes. Individual subject mean baroreflex and non-baroreflex slopes were highly correlated (r = 0.72, P < 0.001). Absolute slope values were not different, and they were unaffected by time, fixed pace breathing, or cold pressor test. The data showed the relatively simple beat-by-beat sequence method to yield spontaneous baroreflex response slopes that were quantitatively similar to, and highly correlated with (r = 0.85-0.94), baroreflex response slopes calculated by spectral analysis methods.

  14. Cyclohexanol analogues are positive modulators of GABA(A) receptor currents and act as general anaesthetics in vivo.

    Science.gov (United States)

    Hall, Adam C; Griffith, Theanne N; Tsikolia, Maia; Kotey, Francesca O; Gill, Nikhila; Humbert, Danielle J; Watt, Erin E; Yermolina, Yuliya A; Goel, Shikha; El-Ghendy, Bahaa; Hall, C Dennis

    2011-09-30

    GABA(A) receptors meet all the pharmacological criteria required to be considered important general anaesthetic targets. In the following study, the modulatory effects of various commercially available and novel cyclohexanols were investigated on recombinant human γ-aminobutyric acid (GABA(A), α(1)β(2)γ(2s)) receptors expressed in Xenopus oocytes, and compared to the modulatory effects on GABA currents observed with exposures to the intravenous anaesthetic agent, propofol. Submaximal EC(20) GABA currents were typically enhanced by co-applications of 3-300 μM cyclohexanols. For instance, at 30 μM 2,6-diisopropylcyclohexanol (a novel compound) GABA responses were increased ~3-fold (although similar enhancements were achieved at 3 μM propofol). As regards rank order for modulation by the cyclohexanol analogues at 30 μM, the % enhancements for 2,6-dimethylcyclohexanol~2,6-diethylcyclohexanol~2,6-diisopropylcyclohexanol~2,6-di-sec-butylcyclohexanol ≫2,6-di-tert-butylcyclohexanol~4-tert-butylcyclohexanol>cyclohexanol~cyclopentanol~2-methylcyclohexanol. We further tested the potencies of the cyclohexanol analogues as general anaesthetics using a tadpole in vivo assay. Both 2,6-diisopropylcyclohexanol and 2,6-dimethylcyclohexanol were effective as anaesthetics with EC(50)s of 14.0 μM and 13.1 μM respectively, while other cyclohexanols with bulkier side chains were less potent. In conclusion, our data indicate that cyclohexanols are both positive modulators of GABA(A) receptors currents and anaesthetics. The positioning and size of the alkyl groups at the 2 and 6 positions on the cyclohexanol ring were critical determinants of activity. Copyright © 2011 Elsevier B.V. All rights reserved.

  15. Effects of ion channel noise on neural circuits: an application to the respiratory pattern generator to investigate breathing variability.

    Science.gov (United States)

    Yu, Haitao; Dhingra, Rishi R; Dick, Thomas E; Galán, Roberto F

    2017-01-01

    Neural activity generally displays irregular firing patterns even in circuits with apparently regular outputs, such as motor pattern generators, in which the output frequency fluctuates randomly around a mean value. This "circuit noise" is inherited from the random firing of single neurons, which emerges from stochastic ion channel gating (channel noise), spontaneous neurotransmitter release, and its diffusion and binding to synaptic receptors. Here we demonstrate how to expand conductance-based network models that are originally deterministic to include realistic, physiological noise, focusing on stochastic ion channel gating. We illustrate this procedure with a well-established conductance-based model of the respiratory pattern generator, which allows us to investigate how channel noise affects neural dynamics at the circuit level and, in particular, to understand the relationship between the respiratory pattern and its breath-to-breath variability. We show that as the channel number increases, the duration of inspiration and expiration varies, and so does the coefficient of variation of the breath-to-breath interval, which attains a minimum when the mean duration of expiration slightly exceeds that of inspiration. For small channel numbers, the variability of the expiratory phase dominates over that of the inspiratory phase, and vice versa for large channel numbers. Among the four different cell types in the respiratory pattern generator, pacemaker cells exhibit the highest sensitivity to channel noise. The model shows that suppressing input from the pons leads to longer inspiratory phases, a reduction in breathing frequency, and larger breath-to-breath variability, whereas enhanced input from the raphe nucleus increases breathing frequency without changing its pattern. A major source of noise in neuronal circuits is the "flickering" of ion currents passing through the neurons' membranes (channel noise), which cannot be suppressed experimentally. Computational

  16. Trained breathing-induced oxygenation acutely reverses cardiovascular autonomic dysfunction in patients with type 2 diabetes and renal disease.

    Science.gov (United States)

    Esposito, Pasquale; Mereu, Roberto; De Barbieri, Giacomo; Rampino, Teresa; Di Toro, Alessandro; Groop, Per-Henrik; Dal Canton, Antonio; Bernardi, Luciano

    2016-04-01

    Cardiovascular autonomic dysfunction, evaluated as baroreflex sensitivity (BRS), could be acutely corrected by slow breathing or oxygen administration in patients with type 1 diabetes, thus suggesting a functional component of the disorder. We tested this hypothesis in patients with the type 2 diabetes with or without renal impairment. Twenty-six patients with type 2 diabetes (aged 61.0 ± 0.8 years, mean ± SEM; duration of diabetes 10.5 ± 2 years, BMI 29.9 ± 0.7 kg/m(2), GFR 68.1 ± 5.6 ml/min) and 24 healthy controls (aged 58.5 ± 1.0 years) were studied. BRS was obtained from recordings of RR interval and systolic blood pressure fluctuations during spontaneous and during slow, deep (6 breaths/min) controlled breathing in conditions of normoxia or hyperoxia (5 l/min oxygen). During spontaneous breathing, diabetic patients had lower RR interval and lower BRS compared with the control subjects (7.1 ± 1.2 vs. 12.6 ± 2.0 ms/mmHg, p breathing and oxygen administration significantly increased arterial saturation, reduced RR interval and increased BRS in both groups (to 9.6 ± 1.8 and 15.4 ± 2.4 ms/mmHg, respectively, p breathing and hyperoxia (p breathing during normoxia). Autonomic dysfunction present in patients with type 2 diabetes can be partially reversed by slow breathing, suggesting a functional role of hypoxia, also in patients with DKD. Interventions known to relieve tissue hypoxia and improve autonomic function, like physical activity, may be useful in the prevention and management of complications in patients with diabetes.

  17. Spontaneous subcapsular and perirrenal hemorrhage

    International Nuclear Information System (INIS)

    Fuster, M.J.; Saez, J.; Perez-Paya, F.J.; Fernandez, F.

    1997-01-01

    To assess the role of CT in the etiologic diagnosis of spontaneous subcapsular and perirrenal hemorrhage. The CT findings are described in 13 patients presenting subcapsular and perirrenal hemorrhage. Those patients in whom the bleeding was not spontaneous were excluded. Surgical confirmation was obtained in nine cases. In 11 of the 13 cases (84.6%), involving five adenocarcinomas, five angiomyolipoma, two complicated cysts and one case of panarterities nodosa, CT disclosed the underlying pathology. In two cases (15.4%), it only revealed the extension of the hematoma, but gave no clue to its origin. CT is the technique of choice when spontaneous subcapsular and perirrenal hemorrhage is suspected since, in most cases, it reveals the underlying pathology. (Author)

  18. Hypersensitivity to local anaesthetics--update and proposal of evaluation algorithm

    DEFF Research Database (Denmark)

    Thyssen, Jacob Pontoppidan; Menné, Torkil; Elberling, Jesper

    2008-01-01

    Local anaesthetics (LA) are widely used drugs. Adverse reactions are rare but may be caused by delayed-type hypersensitivity reactions and probably also immediate-type reactions. As it is not always easy to clinically differ between these subtypes, allergy skin testing should be considered....... Although numerous test protocols have been published, how patients with hypersensitivity reactions to LA are ideally evaluated remains a topic of discussion. This review attempts to generate a comprehensive update on allergic reactions to LA and to present an algorithm that can be used for the evaluation...... of patients suspected with immediate- and delayed-type immune reactions. Literature was examined using PubMed-Medline, EMBASE, Biosis and Science Citation Index. Based on the literature, the proposed algorithm may safely and rapidly distinguish between immediate-type and delayed-type allergic immune reactions....

  19. Conjugates of methylated cyclodextrin derivatives and hydroxyethyl starch (HES: Synthesis, cytotoxicity and inclusion of anaesthetic actives

    Directory of Open Access Journals (Sweden)

    Lisa Markenstein

    2014-12-01

    Full Text Available The mono-6-deoxy-6-azides of 2,6-di-O-methyl-β-cyclodextrin (DIMEB and randomly methylated-β-cyclodextrin (RAMEB were conjugated to propargylated hydroxyethyl starch (HES by Cu+-catalysed [2 + 3] cycloaddition. The resulting water soluble polymers showed lower critical solution temperatures (LCST at 52.5 °C (DIMEB-HES and 84.5 °C (RAMEB-HES, respectively. LCST phase separations could be completely avoided by the introduction of a small amount of carboxylate groups at the HES backbone. The methylated CDs conjugated to the HES backbone exhibited significantly lower cytotoxicities than the corresponding monomeric CD derivatives. Since the binding potentials of these CD conjugates were very high, they are promising candidates for new oral dosage forms of anaesthetic actives.

  20. Quantification of anaesthetic effects on atrial fibrillation rate by partial least-squares

    International Nuclear Information System (INIS)

    Cervigón, R; Moreno, J; Pérez-Villacastín, J; Reilly, R B; Castells, F

    2012-01-01

    The mechanism underlying atrial fibrillation (AF) remains poorly understood. Multiple wandering propagation wavelets drifting through both atria under hierarchical models are not understood. Some pharmacological drugs, known as antiarrhythmics, modify the cardiac ionic currents supporting the fibrillation process within the atria and may modify the AF propagation dynamics terminating the fibrillation process. Other medications, theoretically non-antiarrhythmic, may slightly affect the fibrillation process in non-defined mechanisms. We evaluated whether the most commonly used anaesthetic agent, propofol, affects AF patterns. Partial least-squares (PLS) analysis was performed to reduce significant noise into the main latent variables to find the differences between groups. The final results showed an excellent discrimination between groups with slow atrial activity during the propofol infusion. (paper)

  1. Transient neurologic symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics

    DEFF Research Database (Denmark)

    Zaric, Dusanka; Pace, Nathan Leon

    2009-01-01

    ); and handsearched the reference lists of trials and review articles. SELECTION CRITERIA: We included all randomized and quasi-randomized studies comparing the frequency of TNS and neurologic complications after spinal anaesthesia with lidocaine as compared to other local anaesthetics. DATA COLLECTION AND ANALYSIS......BACKGROUND: Spinal anaesthesia has been in use since 1898. During the last decade there has been an increase in the number of reports implicating lidocaine as a possible cause of temporary and permanent neurologic complications after spinal anaesthesia. Follow up of patients who received...... uncomplicated spinal anaesthesia revealed that some of them developed pain in the lower extremities after an initial full recovery. This painful condition that occurs in the immediate postoperative period was named 'transient neurologic symptoms' (TNS). OBJECTIVES: To study the frequency of TNS and neurologic...

  2. Anaesthetic management of shoulder arthroscopic repair in Parkinson′s disease with deep brain stimulator

    Directory of Open Access Journals (Sweden)

    Ranju Gandhi

    2014-01-01

    Full Text Available We describe the anaesthetic management of arthroscopic repair for complete rotator cuff tear of shoulder in a 59-year-old female with Parkinson′s disease (PD with deep brain stimulator (DBS using a combination of general anaesthesia with interscalene approach to brachial plexus block. The DBS consists of implanted electrodes in the brain connected to the implantable pulse generator (IPG normally placed in the anterior chest wall subcutaneously. It can be programmed externally from a hand-held device placed directly over the battery stimulator unit. In our patient, IPG with its leads was located in close vicinity of the operative site with potential for DBS malfunction. Implications of DBS in a patient with PD for shoulder arthroscopy for anaesthesiologist are discussed along with a brief review of DBS.

  3. Anaesthetic management of craniotomy for intracranial lesion in a child with uncorrected Tetrology of Fallot

    International Nuclear Information System (INIS)

    Rafique, N. B.; Hamid, M.

    2013-01-01

    The case of a 16 years old female with uncorrected Tetrology of Fallot, who operated for intracranial lesion in parieto frontal area with midline shift is presented. She had right ventricular hypertrophy, clubbing, central and peripheral cyanosis. Patient was anaesthetized keeping all measures required to avoid haemodynamic swings, tachycardia, desaturation, acidosis and dehydration. Pre-operative antibiotic cover was given to prevent bacterial endocarditis. Neurosurgeon, Paediatric cardiologist, Anaesthesiologist and Intensivist were involved in the preoperative planning and management of the patient. Haemodynamics were maintained and managed by monitoring continuous arterial line secured pre-induction and central line after induction. During surgery pain was controlled with fentanyl boluses intra-operatively and post operatively by tramadol infusion. Patient was extubated post operatively in the recovery room fulfilling the extubation criteria. She remained haemodynamically stable throughout the course. She was discharged on 5th post operative day from the hospital on SpO/sub 2/ of 70-80% at room air. (author)

  4. Anaesthetic management of a patient with Pompe disease for kyphoscoliosis correction

    Directory of Open Access Journals (Sweden)

    Vaishali Kumbar

    2016-01-01

    Full Text Available Pompe disease (PD is a type II glycogen storage disease, characterised by abnormal glycogen deposition, mainly in heart and skeletal muscles, leading to progressive loss of muscle function. The infantile variety is associated with severe hypertrophic cardiomyopathy and generally do not reach adulthood. The juvenile variety presents with progressive muscle weakness and respiratory failure. Anaesthetic management concerns in the patient reported here were mainly due to respiratory failure, myopathy and sensitivity to muscle relaxants and significant haemodynamic changes perioperatively. We successfully managed a 13-year-old girl with juvenile PD on respiratory support scheduled for thoracolumbar kyphoscoliosis corrective surgery. Ketamine and dexmedetomidine were used for induction of anaesthesia and maintenance. Muscle relaxants were diligently avoided in this case.

  5. Anaesthetic management in patients with glucose-6-phosphate dehydrogenase deficiency undergoing neurosurgical procedures

    Directory of Open Access Journals (Sweden)

    Sebastian Valiaveedan

    2011-01-01

    Full Text Available Glucose-6-phosphate dehydrogenase (G-6-PD deficiency is an X-linked recessive enzymopathy responsible for acute haemolysis following exposure to oxidative stress. Drugs which induce haemolysis in these patients are often used in anaesthesia and perioperative pain management. Neurosurgery and few drugs routinely used during these procedures are known to cause stress situations. Associated infection and certain foodstuffs are also responsible for oxidative stress. Here, we present two patients with G-6-PD deficiency who underwent uneventful neurosurgical procedures. The anaesthetic management in such patients should focus on avoiding the drugs implicated in haemolysis, reducing the surgical stress with adequate analgesia, and monitoring for and treating the haemolysis, should it occur.

  6. Decreased chewing activity during mouth breathing.

    Science.gov (United States)

    Hsu, H-Y; Yamaguchi, K

    2012-08-01

    This study examined the effect of mouth breathing on the strength and duration of vertical effect on the posterior teeth using related functional parameters during 3 min of gum chewing in 39 nasal breathers. A CO(2) sensor was placed over the mouth to detect expiratory airflow. When no airflow was detected from the mouth throughout the recording period, the subject was considered a nasal breather and enrolled in the study. Electromyographic (EMG) activity was recorded during 3 min of gum chewing. The protocol was repeated with the nostrils occluded. The strength of the vertical effect was obtained as integrated masseter muscle EMG activity, and the duration of vertical effect was also obtained as chewing stroke count, chewing cycle variation and EMG activity duration above baseline. Baseline activity was obtained from the isotonic EMG activity during jaw movement at 1.6 Hz without making tooth contact. The duration represented the percentage of the active period above baseline relative to the 3-min chewing period. Paired t-test and repeated analysis of variance were used to compare variables between nasal and mouth breathing. The integrated EMG activity and the duration of EMG activity above baseline, chewing stroke count and chewing cycle significantly decreased during mouth breathing compared with nasal breathing (Pbreathing was significantly greater than nasal breathing (Pbreathing reduces the vertical effect on the posterior teeth, which can affect the vertical position of posterior teeth negatively, leading to malocclusion. © 2012 Blackwell Publishing Ltd.

  7. Sudarshan kriya yoga: Breathing for health

    Directory of Open Access Journals (Sweden)

    Sameer A Zope

    2013-01-01

    Full Text Available Breathing techniques are regularly recommended for relaxation, stress management, control of psychophysiological states, and to improve organ function. Yogic breathing, defined as a manipulation of breath movement, has been shown to positively affect immune function, autonomic nervous system imbalances, and psychological or stress-related disorders. The aim of this study was to assess and provide a comprehensive review of the physiological mechanisms, the mind-body connection, and the benefits of Sudarshan Kriya Yoga (SKY in a wide range of clinical conditions. Various online databases searched were Medline, Psychinfo, EMBASE, and Google Scholar. All the results were carefully screened and articles on SKY were selected. The references from these articles were checked to find any other potentially relevant articles. SKY, a unique yogic breathing practice, involves several types of cyclical breathing patterns, ranging from slow and calming to rapid and stimulating. There is mounting evidence to suggest that SKY can be a beneficial, low-risk, low-cost adjunct to the treatment of stress, anxiety, post-traumatic stress disorder, depression, stress-related medical illnesses, substance abuse, and rehabilitation of criminal offenders.

  8. The clinical value of breath hydrogen testing.

    Science.gov (United States)

    Yao, Chu K; Tuck, Caroline J

    2017-03-01

    Breath hydrogen testing for assessing the presence of carbohydrate malabsorption is frequently applied to refine dietary restrictions on a low fermentable carbohydrate (FODMAP) diet. Its application has also been extended for the detection of small intestinal bacterial overgrowth. Recently, several caveats of its methodology and interpretation have emerged. A review of the evidence surrounding its application in the management of patients with a functional bowel disorder was performed. Studies were examined to assess limitations of testing methodology, interpretation of results, reproducibility, and how this relates to clinical symptoms. A wide heterogeneity in testing parameters, definition of positive/negative response, and the use of clinically irrelevant doses of test carbohydrate were common methodological limitations. These factors can subsequently impact the sensitivity, specificity, and false positive or negative detection rates. Evidence is also increasing on the poor intra-individual reproducibility in breath responses with repeated testing for fructose and lactulose. On the basis of these limitations, it is not surprising that the diagnosis of small intestinal bacterial overgrowth based on a lactulose breath test yields a wide prevalence rate and is unreliable. Finally, symptom induction during a breath test has been found to correlate poorly with the presence of carbohydrate malabsorption. The evidence suggests that breath hydrogen tests have limited clinical value in guiding clinical decision for the patient with a functional bowel disorder. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  9. Anaesthetic induction and recovery characteristics of a diazepam-ketamine combination compared with propofol in dogs.

    Science.gov (United States)

    Ferreira, Jacques P; Dzikit, T Brighton; Zeiler, Gareth E; Buck, Roxanne; Nevill, Bruce; Gummow, Bruce; Bester, Lynette

    2015-06-01

    Induction of anaesthesia occasionally has been associated with undesirable behaviour in dogs. High quality of induction of anaesthesia with propofol has been well described while in contrast variable induction and recovery quality has been associated with diazepam-ketamine. In this study, anaesthetic induction and recovery characteristics of diazepam-ketamine combination with propofol alone were compared in dogs undergoing elective orchidectomy. Thirty-six healthy adult male dogs were used. After habitus scoring (simple descriptive scale [SDS]), the dogs were sedated with morphine and acepromazine. Forty minutes later a premedication score (SDS) was allocated and general anaesthesia was induced using a combination of diazepam-ketamine (Group D/K) or propofol (Group P) and maintained with isoflurane. Scores for the quality of induction, intubation and degree of myoclonus were allocated (SDS). Orchidectomy was performed after which recovery from anaesthesia was scored (SDS) and times to extubation and standing were recorded. Data were analysed using descriptive statistics and Kappa Reliability and Kendall Tau B tests. Both groups were associated with acceptable quality of induction and recovery from anaesthesia. Group P, however, was associated with a poorer quality of induction (p = 0.014), prolonged induction period (p = 0.0018) and more pronounced myoclonus (p = 0.003), but had better quality of recovery (p = 0.000002) and shorter recovery times (p = 0.035) compared with Group D/K. Diazepam-ketamine and propofol are associated with acceptable induction and recovery from anaesthesia. Propofol had inferior anaesthetic induction characteristics, but superior and quicker recovery from anaesthesia compared with diazepam-ketamine.

  10. Anaesthetic and other treatments of shell shock: World War I and beyond.

    Science.gov (United States)

    McKenzie, A G

    2012-03-01

    Post-traumatic stress disorder (PTSD) is an important health risk factor for military personnel deployed in modern warfare. In World War I this condition (then known as shell shock or 'neurasthenia') was such a problem that 'forward psychiatry' was begun by French doctors in 1915. Some British doctors tried general anaesthesia as a treatment (ether and chloroform), while others preferred application of electricity. Four British 'forward psychiatric units' were set up in 1917. Hospitals for shell shocked soldiers were also established in Britain, including (for officers) Craiglockhart War Hospital in Edinburgh; patients diagnosed to have more serious psychiatric conditions were transferred to the Royal Edinburgh Asylum. Towards the end of 1918 anaesthetic and electrical treatments of shell shock were gradually displaced by modified Freudian methods psychodynamic intervention. The efficacy of 'forward psychiatry' was controversial. In 1922 the War Office produced a report on shell shock with recommendations for prevention of war neurosis. However, when World War II broke out in 1939, this seemed to have been ignored. The term 'combat fatigue' was introduced as breakdown rates became alarming, and then the value of pre-selection was recognised. At the Maudsley Hospital in London in 1940 barbiturate abreaction was advocated for quick relief from severe anxiety and hysteria, using i.v. anaesthetics: Somnifaine, paraldehyde, Sodium Amytal. 'Pentothal narcosis' and 'narco-analysis' were adopted by British and American military psychiatrists. However, by 1945 medical thinking gradually settled on the same approaches that had seemed to be effective in 1918. The term PTSD was introduced in 1980. In the UK the National Institute for Health and Clinical Excellence (NICE) guidelines for management (2005) recommend trauma-focussed Cognitive Behavioural Therapy and consideration of antidepressants.

  11. Optimised NLC: a nanotechnological approach to improve the anaesthetic effect of bupivacaine.

    Science.gov (United States)

    Rodrigues da Silva, Gustavo H; Ribeiro, Lígia N M; Mitsutake, Hery; Guilherme, Viviane A; Castro, Simone R; Poppi, Ronei J; Breitkreitz, Márcia C; de Paula, Eneida

    2017-08-30

    The short time of action and systemic toxicity of local anaesthetics limit their clinical application. Bupivacaine is the most frequently used local anaesthetic in surgical procedures worldwide. The discovery that its S(-) enantiomeric form is less toxic than the R(+) form led to the introduction of products with enantiomeric excess (S75:R25 bupivacaine) in the market. Nevertheless, the time of action of bupivacaine is still short; to overcome that, bupivacaine S75:R25 (BVC S75 ) was encapsulated in nanostructured lipid carriers (NLC). In this work, we present the development of the formulation using chemometric tools of experimental design to study the formulation factors and Raman mapping associated with Classical Least Squares (CLS) to study the miscibility of the solid and the liquid lipids. The selected formulation of the nanostructured lipid carrier containing bupivacaine S75:R25 (NLC BVC ) was observed to be stable for 12 months under room conditions regarding particle size, polydispersion, Zeta potential and encapsulation efficiency. The characterisation by DSC, XDR and TEM confirmed the encapsulation of BVC S75 in the lipid matrix, with no changes in the structure of the nanoparticles. The in vivo analgesic effect elicited by NLC BVC was twice that of free BVC S75 . Besides improving the time of action , no statistical difference in the blockage of the sciatic nerve of rats was found between 0.125% NLC BVC and 0.5% free BVC S75 . Therefore, the formulation allows a reduction in the required anaesthesia dose, decreasing the systemic toxicity of bupivacaine, and opening up new possibilities for different clinical applications. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Intraoperative esmolol infusion reduces postoperative analgesic consumption and anaesthetic use during septorhinoplasty: a randomized trial

    Directory of Open Access Journals (Sweden)

    Nalan Celebi

    2014-09-01

    Full Text Available Background and objectives: Esmolol is known to have no analgesic activity and no anaesthetic properties; however, it could potentiate the reduction in anaesthetic requirements and reduce postoperative analgesic use. The objective of this study is to evaluate the effect of intravenous esmolol infusion on intraoperative and postoperative analgesic consumptions as well as its effect on depth of anaesthesia. Methods: This randomized-controlled double blind study was conducted in a tertiary care hospital between March and June 2010. Sixty patients undergoing septorhinoplasty were randomized into two groups. History of allergy to drugs used in the study, ischaemic heart disease, heart block, bronchial asthma, hepatic or renal dysfunction, obesity and a history of chronic use of analgesic or β-blockers were considered cause for exclusion from the study. Thirty patients received esmolol and remifentanil (esmolol group and 30 patients received normal saline and remifentanil (control group as an intravenous infusion during the procedure. Mean arterial pressure, heart rate, and bispectral index values were recorded every 10min. Total remifentanil consumption, visual analogue scale scores, time to first analgesia and total postoperative morphine consumption were recorded. Results: The total remifentanil consumption, visual analogue scale scores at 0, 20 and 60 min, total morphine consumption, time to first analgesia and the number of patients who needed an intravenous morphine were lower in the esmolol group. Conclusions: Intravenous infusion of esmolol reduced the intraoperative and postoperative analgesic consumption, reduced visual analogue scale scores in the early postoperative period and prolonged the time to first analgesia; however it did not influence the depth of anaesthesia.

  13. Survey of Emergency and Essential Surgical, Obstetric and Anaesthetic Services Available in Bangladeshi Government Health Facilities.

    Science.gov (United States)

    Loveday, Jonathan; Sachdev, Sonal P; Cherian, Meena N; Katayama, Francisco; Akhtaruzzaman, A K M; Thomas, Joe; Huda, N; Faragher, E Brian; Johnson, Walter D

    2017-07-01

    Evaluate the capacity of government-run hospitals in Bangladesh to provide emergency and essential surgical, obstetric and anaesthetic services. Cross-sectional survey of 240 Bangladeshi Government healthcare facilities using the World Health Organisation Situational Analysis Tool to Assess Emergency and Essential Surgical Care (SAT). This tool evaluates the ability of a healthcare facility to provide basic surgical, obstetric and anaesthetic care based on 108 queries that detail the infrastructure and population demographics, human resources, surgical interventions and reason for referral, and available surgical equipment and supplies. For this survey, the Bangladeshi Ministry of Health sent the SAT to sub-district, district/general and teaching hospitals throughout the country in April 2013. Responses were received from 240 healthcare facilities (49.5% response rate): 218 sub-district and 22 district/general hospitals. At the sub-district level, caesarean section was offered by 55% of facilities, laparotomy by 7% and open fracture repair by 8%. At the district/general hospital level, 95% offered caesarean section, 86% offered laparotomy and 77% offered open fracture treatment. Availability of anaesthesia services, general equipment and supplies reflected this trend, where district/general hospitals were better equipped than sub-district hospitals, though equipment and infrastructure shortages persist. There has been overall impressive progress by the Bangladeshi Government in providing essential surgical services. Areas for improvement remain across all key areas, including infrastructure, human resources, surgical interventions offered and available equipment. Investment in surgical services offers a cost-effective opportunity to continue to improve the health of the Bangladeshi population and move the country towards universal healthcare coverage.

  14. Serum cortisol of Sahel goats following rumenotomy with assorted anaesthetics and sutures

    Directory of Open Access Journals (Sweden)

    Abubakar Mshelia Saidu

    2016-06-01

    Full Text Available The utmost need for pragmatic combination of surgical sutures and local anaesthetic that would evoke minimal post-surgical stress response and allow uncomplicated healing is essential for successful surgeries. Fifteen Sahel goats were randomly allocated into three groups A, B and C to quantitatively assay (ELISA serum cortisol profiles following rumenotomy, as markers of surgical stress. Diazepam at 0.2 mg/kg was administered intravenously to groups A and B with subsequent lidocaine HCl and bupivacaine inverted-L block respectively. Group C did not receive any treatment. Chromic catgut (CCG and polyglycolic acid (PGA sutures were used for rumen and abdominal muscles closure for groups A and B respectively and nylon for skin closure. Blood samples were taken at post anaesthetic induction (PAI and post-surgery at 0, 5, 8, 24, 48 and 72 h. The Group A goats expressed serum cortisol that was significantly high 52.76 ± 6.12 ng/mL at 5 h post-surgery. At 8 h post-surgery serum cortisol for both groups A (72.53 ± 3.79 ng/mL and B (61.59 ± 3.90 ng/mL were at their peak. Serum cortisol levels compared to the baseline data were significantly different (P  0.05. Cortisol responses unambiguously indicate that diazepam-bupivacaine induce less stress than Diazepam-lidocaine, hence a preferred anesthesia. Moreover, polyglycolic acid sutures are associated with less inflammatory reaction than chromic catgut.

  15. National survey on perioperative anaesthetic management in the endovascular treatment of acute ischaemic stroke.

    Science.gov (United States)

    Romero Kräuchi, O; Valencia, L; Iturri, F; Mariscal Ortega, A; López Gómez, A; Valero, R

    2018-01-01

    To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72.9%). Health coverage for AIS endovascular treatment was available 24hours a day in 63% of the hospitals. The anaesthesiologist in charge of the procedure was physically present in the hospital in 55.3%. There was large inter-hospital variability in non-standard monitoring and type of anaesthesia. The most important criterion for selecting type of anaesthesia was multidisciplinary choice made by the anaesthesiologist, neurologist and neuroradiologist (59.3%). The duration of time from arrival to arterial puncture was 10-15minutes in 59.2%. In 44.4%, systolic blood pressure was maintained between 140-180mmHg, and diastolic blood pressure<105mmHg. Glycaemic levels were taken in 81.5% of hospitals. Intravenous heparinisation was performed during the procedure in 66.7% with different patterns of action. In cases of moderate neurological deterioration with no added complications, 85.2% of the included hospitals awakened and extubated the patients. The wide variability observed in the anaesthetic management and the organization of the endovascular treatment of AIS demonstrates the need to create common guidelines for anaesthesiologists in Spain. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Anaesthetic induction and recovery characteristics of a diazepam-ketamine combination compared with propofol in dogs

    Directory of Open Access Journals (Sweden)

    Jacques P. Ferreira

    2015-03-01

    Full Text Available Induction of anaesthesia occasionally has been associated with undesirable behaviour in dogs. High quality of induction of anaesthesia with propofol has been well described while in contrast variable induction and recovery quality has been associated with diazepam-ketamine. In this study, anaesthetic induction and recovery characteristics of diazepam-ketamine combination with propofol alone were compared in dogs undergoing elective orchidectomy. Thirty-six healthy adult male dogs were used. After habitus scoring (simple descriptive scale [SDS], the dogs were sedated with morphine and acepromazine. Forty minutes later a premedication score (SDS was allocated and general anaesthesia was induced using a combination of diazepam-ketamine (Group D/K or propofol (Group P and maintained with isoflurane. Scores for the quality of induction, intubation and degree of myoclonus were allocated (SDS. Orchidectomy was performed after which recovery from anaesthesia was scored (SDS and times to extubation and standing were recorded. Data were analysed using descriptive statistics and Kappa Reliability and Kendall Tau B tests. Both groups were associated with acceptable quality of induction and recovery from anaesthesia. Group P, however, was associated with a poorer quality of induction (p = 0.014, prolonged induction period (p = 0.0018 and more pronounced myoclonus (p = 0.003, but had better quality of recovery (p = 0.000002 and shorter recovery times (p = 0.035 compared with Group D/K. Diazepam-ketamine and propofol are associated with acceptable induction and recovery from anaesthesia. Propofol had inferior anaesthetic induction characteristics, but superior and quicker recovery from anaesthesia compared with diazepam-ketamine.

  17. Prick-test evaluation to anaesthetics in patients attending a general allergy clinic.

    Science.gov (United States)

    Tamayo, E; Rodríguez-Ceron, G; Gómez-Herreras, J I; Fernández, A; Castrodeza, J; Alvarez, F J

    2006-12-01

    To analyse the prevalence of positive prick-tests to all medicaments normally checked in allergy units when a patient is suspected of being allergic to anaesthetics. To establish the degree of agreement between the antecedents of a previous history of an allergic reaction to a medicament and the positive result, or not, to the specific prick-test for the said medicament. This was a prospective study, during 2003 and 2004, which analysed 473 patients referred by their doctors to allergy units to make retrospective diagnoses of an allergy to a drug. The prick-test was done using the undiluted drug. All patients were tested for 41 drugs. These include antibiotics, trimethoprim-sulphamethoxazole, non-steroidal anti-inflammatory drugs (NSAIDs) and perioperative drugs (PD): neuromuscular blocking drugs, latex, iodine, local anaesthetics, hypnotics, opioids and coadjuvants. Cohen's Kappa Index was used to determine the degree of agreement. 71.5% of patients studied presented a positive prick-test. The largest number of positive cases was found in antibiotics (56.4%), followed by PD (15.6%), NSAIDs (14.4%) and trimethoprim-sulphamethoxazole (12.7%). Among PD, the highest prevalence of positive prick-tests was found for neuromuscular blocking drugs (5.3%). Agreement between the substance suspected of causing the allergic reaction and the positive prick-test was excellent for penicillin (Kappa = 0.74) and other antibiotics (Kappa = 0.721) and good for NSAIDs (Kappa = 0.47) and iodine (Kappa = 0.54). The prevalence of patients with positive prick-tests to PD occurred in 15.6% in this prospective cohort. Neuromuscular blocking drugs were found to have the highest prevalence of positive prick-tests. There is positive agreement when the substance responsible for the allergic reaction is suspected, otherwise agreement is low.

  18. Anaesthetic specialist registrars in Ireland: current teaching practices and perceptions of their role as undergraduate teachers.

    LENUS (Irish Health Repository)

    Walsh, K

    2012-02-03

    BACKGROUND AND OBJECTIVES: Teaching is an important responsibility of non-consultant hospital doctors. In Ireland, specialist registrars (SpRs) in anaesthesia are contractually obliged to teach medical students, other doctors and nurses. Both medical students and fellow non-consultant hospital doctors attribute between 30 and 40% of their knowledge gain to non-consultant hospital doctors. METHODS: We carried out a confidential telephone survey of anaesthetic SpRs in Ireland regarding their current teaching practices and the perceptions of their role as undergraduate teachers. All the SpRs currently working in clinical practice in Ireland were eligible. RESULTS: Fifty-five of the 79 (70%) SpRs responded to the questionnaire. Only 7 (12.7%) of the respondents said they had been well trained as a teacher. The majority of the respondents stated that they would attend a learning-to-teach course\\/workshop if one was available, and felt that such a course would improve their ability as a teacher. Only 8 (14.5%) agreed that adequate emphasis is placed on commitment to teaching in the assessment of SpRs, both by individual departments and by the College of Anaesthetists. Anaesthetic SpRs in Ireland spend a considerable amount of time each day teaching undergraduate medical students, the majority (68.9%) stated that they had inadequate time to prepare for teaching. CONCLUSION: The majority of the respondents stated that they enjoy teaching, feel that they play an important role in undergraduate teaching but have inadequate time to prepare for teaching. An adequate emphasis is not placed on their commitment to teaching.

  19. Responses of iliac conduit artery and hindlimb resistance vessels to luminal hyperfructosemia in the anaesthetized pig.

    Science.gov (United States)

    Ruane-O'Hora, T; Edge, D; Shortt, C M; Markos, F; Noble, M I M

    2013-12-01

    High fructose levels are found in diabetes mellitus, associated with high corn syrup diets, and have been claimed to cause hypertension. As the direct effects on conduit and resistance arteries have not been previously reported, we measured these in vivo in the anaesthetized pig with instrumented iliac arteries. Experiments were performed on the iliac artery preparation in the anaesthetized pig: blood flow, diameter and pressure were measured in the iliac. The change in diameter of an occluded iliac artery segment filled with hyperfructosemic (15 μm) blood was 89.5 ± 22.1 μm (mean ± SE), contrasted with 7.7 ± 13.06 μm control (P = 0.005, paired t-test, n = 6). There was no significant difference when compared with blood containing both hyperfructosemic blood and the nitric oxide synthesis inhibitor, N(G)-nitro-l-arginine methyl ester (250 μg mL(-1)). Step changes in pressure and flow were achieved by progressive arterial stenosis during control saline and 15 μm min(-1) fructose downstream intra-arterial infusions. Linear regression of the step changes in blood pressure versus the instantaneous step changes in blood flow showed a statistically significant decrease in slope of the conductance (P resistance. Peripheral autoregulation and conduit artery shear-stress-mediated dilatation were not significantly altered. An elevated level of fructose caused dilatation of a conduit artery but constriction of resistance vessels. The latter effect could account, if maintained long-term, for the hypertension claimed to be due to hyperfuctosemia. © 2013 Scandinavian Physiological Society. Published by John Wiley & Sons Ltd.

  20. Anaesthetic induction and recovery characteristics of a diazepam-ketamine combination compared with propofol in dogs

    Directory of Open Access Journals (Sweden)

    Jacques P. Ferreira

    2015-06-01

    Full Text Available Induction of anaesthesia occasionally has been associated with undesirable behaviour in dogs. High quality of induction of anaesthesia with propofol has been well described while in contrast variable induction and recovery quality has been associated with diazepam-ketamine. In this study, anaesthetic induction and recovery characteristics of diazepam-ketamine combination with propofol alone were compared in dogs undergoing elective orchidectomy. Thirty-six healthy adult male dogs were used. After habitus scoring (simple descriptive scale [SDS], the dogs were sedated with morphine and acepromazine. Forty minutes later a premedication score (SDS was allocated and general anaesthesia was induced using a combination of diazepam-ketamine (Group D/K or propofol (Group P and maintained with isoflurane. Scores for the quality of induction, intubation and degree of myoclonus were allocated (SDS. Orchidectomy was performed after which recovery from anaesthesia was scored (SDS and times to extubation and standing were recorded. Data were analysed using descriptive statistics and Kappa Reliability and Kendall Tau B tests. Both groups were associated with acceptable quality of induction and recovery from anaesthesia. Group P, however, was associated with a poorer quality of induction (p = 0.014, prolonged induction period (p = 0.0018 and more pronounced myoclonus (p = 0.003, but had better quality of recovery (p = 0.000002 and shorter recovery times (p = 0.035 compared with Group D/K. Diazepam-ketamine and propofol are associated with acceptable induction and recovery from anaesthesia. Propofol had inferior anaesthetic induction characteristics, but superior and quicker recovery from anaesthesia compared with diazepam-ketamine.