Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 1994
ReviewControl of carbon dioxide levels during neuroanaesthesia: current practice and an appraisal of our reliance upon capnography.
With the widespread availability of capnography, many anaesthetists have swung away from formally verifying hypocapnia by intraoperative arterial blood gas analysis and, instead, have come to rely upon capnography as an acceptable and constant predictor of arterial CO2 tension (PaCO2) during neurosurgery. However, the nature of the arterial-end-tidal CO2 gradient is complex, and is frequently unexpectedly large, or even negative. The importance of close intraoperative CO2 control during neurosurgery--more specifically, routine hyperventilation, and our reliance upon capnography to guide intraoperative management--is reappraised. There is a growing appreciation of the adverse effects of hyperventilation and hypocarbia, especially upon abnormal or ischaemic brain, and it is clear that capnography alone cannot be used to confidently predict the true PaCO2 during neuroanaesthesia.
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We present an automatic closed circuit anaesthesia ventilator designed for routine clinical use. The ventilator combines the benefits of high flow systems and true closed circuits, without their disadvantages. The system can be used with any FiO2, with air or nitrous oxide as carrier gas. ⋯ An automatic flush procedure prevents accumulation of unwanted gases. Operation is as easy as contemporary non-closed circuit ventilators. With this machine, closed circuit anaesthesia is possible from the beginning to the end of the procedure.
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Anaesth Intensive Care · Aug 1994
Letter Case ReportsPulmonary oedema associated with endotracheal tube occlusion.