Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2004
Case ReportsLumbar epidural blood patch to treat a large, symptomatic postsurgical cerebrospinal fluid leak of 5 weeks duration in a 3-year-old.
A 3-yr-old with B-cell lymphoma presented with a 5-wk history of 400 mL/day cerebrospinal fluid (CSF) leak, which precluded chemotherapy, after placement of an Omaya reservoir and drain. Surgical repair was unsuccessful. Symptoms included irritability, failure to eat and noncommunication. After lumbar epidural blood patch with 7 mL the symptoms resolved immediately, allowing recommencement of chemotherapy. Epidural blood patch should be considered as possible early treatment for CSF leaks. ⋯ An epidural blood patch successfully treated a large cerebrospinal fluid leak of long duration in a 3-yr-old. Considering the distress of such a leak to the patient, staff, and parents, epidural blood patch may be considered as an early treatment option.
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Anesthesia and analgesia · Mar 2004
Functional residual capacity and respiratory mechanics as indicators of aeration and collapse in experimental lung injury.
Increased functional residual capacity (FRC) and compliance are two desirable, but seldom measured, effects of positive end-expiratory pressure (PEEP) in mechanically ventilated patients. To assess how these variables reflect the morphological lung perturbations during the evolution of acute lung injury and the morphological changes from altered PEEP, we correlated measurements of FRC and respiratory system mechanics to the degree of lung aeration and consolidation on computed tomography (CT). We used a porcine oleic acid model with FRC determinations by sulfur hexafluoride washin-washout and respiratory system mechanics measured during an inspiratory hold maneuver. Within the first hour, during constant volume-controlled ventilation with PEEP 5 cm H(2)O, FRC decreased by 45% +/- 15% (P = 0.005) and compliance decreased by 35% +/- 12% (P = 0.005). Resistance increased by 60% +/- 62% (P = 0.005). Only the FRC changes correlated significantly to the decreased aeration (R(2) = 0.56; P = 0.01) and the increased consolidation (R(2) = 0.43; P = 0.04) on CT. When the PEEP was changed to either 10 or 0 cm H(2)O, there were larger changes in FRC than in compliance. We conclude that, in our model, FRC was a more sensitive indicator of PEEP-induced aeration and recruitment of lung tissue and that FRC may be a useful adjunct to PaO(2) monitoring. ⋯ Lung injury was quantified on computed tomography and related to monitored values of functional residual capacity and mechanical properties of the respiratory system. We found the functional residual capacity to be a more sensitive marker of the lung perturbations than the compliance. It might be of value to include functional residual capacity in the monitoring of acute lung injury.
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Anesthesia and analgesia · Mar 2004
The effects of hydroxyethyl starch on lung capillary permeability in endotoxic rats and possible mechanisms.
In this study we examined the effects of hydroxyethyl starch (HES 200/0.5) on lung capillary permeability in endotoxic rats and explored the possible mechanisms. Male Wistar rats were randomly divided into seven groups treated with saline, lipopolysaccharide (LPS; 6 mg/kg), LPS plus HES (3.75, 7.5, 15, or 30 mL/kg), or HES (30 mL/kg) alone for 4 or 2 h. Lung capillary permeability, lung neutrophil accumulation, expression of CD11b on the blood neutrophil cell surface, lung cytokine-induced neutrophil chemoattractant protein level, and nuclear factor kappa B (NF-kappaB) activation in blood neutrophils and lungs were measured. HES at doses of 3.75 and 7.5 mL/kg significantly reduced LPS-induced increases of lung capillary permeability. HES was found to inhibit lung neutrophil accumulation, cytokine-induced neutrophil chemoattractant protein, and NF-kappaB activation in parallel and to inhibit CD11b expression in a dose-dependent manner. These findings demonstrate that HES has beneficial effects on capillary leak in acute lung injury and that the mechanisms underlying this action involve an antiinflammatory effect of HES, including inhibition of NF-kappaB activation. ⋯ A randomized, controlled laboratory experiment indicated that hydroxyethyl starch (HES) could reduce increased lung capillary permeability in endotoxemia. This effect may be due to an antiinflammatory effect of HES.