Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1976
Breathing mechanics, dead space and gas exchange in the extremely obese, breathing spontaneously and during anaesthesia with intermittent positive pressure ventilation.
Breathing mechanics and gas exchange were studied in 10 extremely obese subjects (average weight 138 kg) prior to and during anaesthesia with mechanical ventilation. Breathing mechanics were analysed from measurements of transpulmonary pressure (during anaesthesia, trans-chest wall pressure as well) inspiratory gas flow and tidal volume. Gas exchange was studied by analysing inspired and from the Bohr equation, and the division into anatomical and alveolar dead space was arrived at by capnography. ⋯ A moderate hypoxaemia was recorded during spontaneous breathing, and the alveolar-arterial oxygen tension difference was slightly elevated. During anaesthesia this difference was markedly greater. It is concluded that the most probable reason for the relative hypoxaemia is right-to-left shunting.
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An open reservoir for the collection and evacuation of anaesthetic gases permits leakage to room air. The use of a closed reservior for the removal of overspill gas from anaesthetic circuits is described. Calibrated gas evacuation is carried out through an ejector flowmeter from the anesthetic circuit or from a closed reservoir, where the gas is collected via a relief valve. In order to eliminate the risk of high or low pressure in the reservoir employed, a relief valve and a dumping valve is included in the system.
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Acta Anaesthesiol Scand · Jan 1976
Jet ventilation for fiberoptic bronchoscopy under general anesthesia.
An oxygen jet method ventilating patients during laryngoscopy has been applied to fiberoptic bronchoscopy. A 3.5 mm plastic tube 24.5 cm long was inserted into the trachea through the mouth. An intermittent jet of oxygen at 3.5 atm (50 psi) was applied to this tube using a 1.5 mm ID plastic catheter to ventilate the patient. ⋯ The high PO2 levels were maintained even during suctioning. General anesthesia for fiberoptic bronchoscopy can be performed using an endotracheal tube not smaller than 8 mm internal diameter (ID). The advantages of the oxygen jet technique are that it can be used in smaller patients and that the upper airway can be examined.
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Acta Anaesthesiol Scand · Jan 1975
Complications to tracheostomy and long-term intubation: a follow-up study.
Hospital records of 79 patients treated with tracheostomy or long-term intubation from 1969 to 1971 were reviewed, and the 43 surviving patients were examined by laryngoscopy, x-ray and spirometry for complications subsequent to these treatments. Early complications included one tube occlusion and one case of postextubation stridor in each group, one dislocated tube, one bilateral pneumothorax, and one case of fatal innominate arterial hemorrhage in the tracheostomy group, and two cases of atelectasis in the long-term intubation group. ⋯ Late complications in surviving patients were prolonged hoarseness in six patients treated with prolonged intubation, two of whom had also had tracheostomy. Radiologically verified tracheal stenosis (40-60%), four at the stoma level and one at the cuff level, all occurred in the tracheostomy group.
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Acta Anaesthesiol Scand · Jan 1975
Anesthesia for cesarean section II: effects of the induction-delivery interval on the respiratory adaptation of the newborn in elective cesarean section.
Ten healthy mothers and their infants were studied in connection with elective cesarean section. Anesthesia was induced with 250-300 mg hexobarbitone followed by 100 mg succinylcholine for endotracheal intubation. The surgeon started the operation when the eyelid reflex disappeared, and delivered the baby as quickly as possible. ⋯ At the interviews, two mothers complained of pain during skin incision, and two of nightmares. Anesthesia with barbiturate for cesarean section with the I-D intervals studied in both groups allowed good respiratory adaptation in the infants. There is, neverless, the need for an adequate period of time between induction and the start of the operation in order to minimize the risk for maternal awareness.