Critical care medicine
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Critical care medicine · Nov 1980
Comparative StudyHemodynamic responses to different modes of mechanical ventilation in dogs with normal and acid aspirated lungs.
Hemodynamic function during spontaneous breathing (SB), IMV, IPPV, continuous positive airway pressure with 10 torr PEEP (CPAP10), IMV with 10 torr PEEP (IMV10), and continuous positive pressure ventilation with 10 torr PEEP (CPPV10) were studied in 13 normovolemic anesthetized dogs. Hemodynamic function was also studied during each type of ventilation after inducing acid aspiration with 0.1 molar HCl, 5 ml/kg, in these animals. In normal dogs, hemodynamic function during IMV and IPPV did not differ significantly from that observed in spontaneously breathing dogs. ⋯ CPPV10 increased pulmonary vascular resistance and avDO2 compared to SB, decreased cardiac index compared to SB and IMV, decreased stroke index compared to SB, IMV, and CPAP10 and increased systemic vascular resistance compared to SB, IMV, IPPV, and CPAP10. Comparing percentage change of cardiac and stroke indices before and after aspiration indicated that the decrease in lung compliance caused by acid aspiration did not prevent the hemodynamic effects of different types of ventilation. Among different types of mechanical ventilation with PEEP, CPAP10 caused the least cardiovascular depression.
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Critical care medicine · Nov 1980
Letter Case ReportsDantrolene therapy for malignant hyperthermia.
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Critical care medicine · Oct 1980
Recent advances in the postoperative care of the pediatric cardiac surgical patient.
Contributions from many fields continue to add to the dynamism of the total care experience of the pediatric cardiac surgery patient. Pharmacological support of the myocardium intraoperatively with cardioplegia and postoperatively with the specific beta-adrenergic stimulating drugs, dopamine and dobutamine, have added measureably to the improved outlook of the pediatric cardiac surgical patient. Better control of anticoagulation status and better utilization of blood products are now possible as well.
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Some technical aspects of intraoperative anesthetic care of pediatric surgical patients are discussed. Recent concepts of premedicant, anesthetic and muscle relaxant drugs as related to the pediatric patient are presented. Endotracheal intubation is an integral part of the pediatric anesthetic management. ⋯ Maintenance of a near normal PaCO2 could be accomplished by allowing partial rebreathing during controlled ventilation. Current status of three useful techniques is presented: deliberate hypotension, hemodilution, and the rapid induction-intubation technique for children with a full stomach. Anesthetic considerations of special problems, such as neurosurgery or cardiac surgery and monitoring, are not discussed.