Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jun 1984
Comparative StudyDifferential ventilation and selective PEEP during anaesthesia in the lateral decubitus posture.
The potential of differential ventilation (DV) with selective positive end-expiratory pressure (PEEP) has been tested versus conventional ventilation with and without general PEEP. Gas exchange and central haemodynamics were studied in 15 subjects with no clinical or radiological signs of pulmonary disease. The rationale of the method was to ensure ventilation of the well-perfused dependent lung and to counteract airway closure within that lung. ⋯ P(A-a)o2 was consequently 43% lower than during conventional ventilation without PEEP in the lateral posture (P less than 0.01). Selective PEEP also had less impact on cardiac output than general PEEP (P less than 0.05). It is concluded that DV with even distribution of VT and selective PEEP can reduce the P(A-a)o2 in anaesthetized lung-healthy subjects in the lateral position.
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Acta Anaesthesiol Scand · Jun 1984
Comparative StudyComparison of halothane and enflurane anaesthesia for tonsillectomy in adults.
Halothane and enflurane in combination with N2O/O2 were compared in 103 adults undergoing tonsillectomy. Anaesthesia was induced with thiopental, and intubation was facilitated with suxamethonium. During halothane anaesthesia the mean heart rate ranged from 91 to 106 beats/min and the mean systolic arterial pressure from 111 to 127 mmHg. ⋯ The corresponding figures after enflurane were 2 and 8%. It is concluded that both halothane and enflurane are suitable anaesthetics for tonsillectomy in adults. The most striking difference between the anaesthetics was the significantly more common occurrence of ECG changes during halothane than enflurane anaesthesia.
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The value of continuous transcutaneous oxygen tension (Ptco2) monitoring was assessed during the rapidly changing conditions of oxygenation associated with the commencement of one-lung ventilation (OLV) during thoracic surgery. In ten patients anaesthetized with enflurane-N2O (Fio2 0.5), Pao2, Ptco2, cardiac output and arterial pressure were measured first during two-lung ventilation (TLV) and thereafter at frequent intervals during OLV. These variables remained stable during TLV. ⋯ Ptco2 correlated well with Pao2 during OLV (r = 0.907). The elevated Ptco2 index (Ptco2/Pao2) may be partly due to the delayed response of the Ptco2-detection system in vivo. It is concluded that transcutaneous oxygen monitoring may be used to assess oxygenation in those cases where arterial cannulation is not feasible or if the laboratory conditions cause an undue delay between blood sampling and obtaining the blood-gas data.
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Forty-eight patients subjected to elective surgery were randomly selected for evaluation of neuromuscular transmission in the postoperative period. All patients were anaesthetized with thiopentone, nitrous oxide, fentanyl and pancuronium. On arrival in the postoperative ward, alertness, ability to sustain head lift and the train-of-four (TOF) ratio were estimated. ⋯ There was a poor correlation between TOF ratio and ability to sustain head lift. The study indicates that residual curarization is a not uncommon fact which clinically is hard to assess. The only wat to avoid residual curarization seems to be to monitor the neuromuscular transmission during anaesthesia.