Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2001
Case ReportsInadvertent knotting of a thoracic epidural catheter.
We report a case of corrosive injury of upper gastrointestinal and respiratory tracts scheduled for feeding jejunostomy under thoracic epidural anesthesia. An epidural catheter was inserted at the T8-T9 intervertebral space and threaded 7 cm beyond the tip of the Tuohy needle in a rostral direction. Resistance was noticed during attempts to inject the local anesthetic. ⋯ Following informing the patient of the associated risks, the catheter was retrieved successfully by gentle and steady pulling. A tight double-knot of catheter was found. No neurological sequelae to the procedure were noticed.
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Acta Anaesthesiol Scand · Feb 2001
Clinical TrialMonitoring of end-tidal carbon dioxide partial pressure changes during infrarenal aortic cross-clamping: a non-invasive method to predict unclamping hypotension.
To assess the variations in end-tidal CO2 in response to aortic cross-clamping and the relationship with systolic arterial pressure (SAP) changes induced by unclamping. ⋯ End-tidal CO2 variation monitoring during aortic cross-clamping may provide a reliable and non-invasive method to predict unclamping hypotension. When the aortic clamp was released, systolic hypotension (>20%) occurred in those subjects who had a decrease in end-tidal CO2 greater than 15% during aortic cross-clamping.
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Acta Anaesthesiol Scand · Feb 2001
Warning! Suctioning. A lung model evaluation of closed suctioning systems.
Closed system suctioning, CSS, has been advocated to avoid alveolar collapse. However, ventilator manufacturers indicate that extreme negative pressure levels can be obtained during closed system suctioning, impeding the performance of the ventilator. ⋯ CSS should not be used in volume control ventilation due to risk of high intrinsic PEEP levels at insertion of the catheter and extreme negative pressures during suctioning. Pressure control ventilation produces less intrinsic PEEP effect. The continuous positive airway pressure (CPAP) mode offers the least intrinsic PEEP during insertion of the catheter and least sub-atmospheric pressure during suctioning.
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Acta Anaesthesiol Scand · Feb 2001
Direct tracheal airway pressure measurements are essential for safe and accurate dynamic monitoring of respiratory mechanics. A laboratory study.
All monitoring of respiratory mechanics should depend on tracheal pressures (Trach-P) as endotracheal tube resistance (ETT-Res) will otherwise distort them. The aim of this study was to investigate factors that may vary ETT-Res, causing difficulties in ETT-Res estimation clinically, and to evaluate a method for direct Trach-P measurements to obviate these problems. ⋯ ETT connections and secretions cause a variance in resistance. Tracheal pressure can be measured with high precision with an air- or liquid-filled catheter. An end hole catheter placed within 2 cm above or below the ETT tip will give sufficiently precise measurements for clinical purposes.
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Acta Anaesthesiol Scand · Feb 2001
Clinical TrialDescending aortic blood flow and cardiac output: a clinical and experimental study of continuous oesophageal echo-Doppler flowmetry.
Several studies have demonstrated that perioperative optimisation of oxygen delivery and haemodynamics can reduce mortality and morbidity for high-risk surgical patients. To optimise cardiac output, reliable, continuous and "less invasive" methods for measuring cardiac output are urgently needed. ⋯ A combined echo-Doppler technique can be valuable for continuous monitoring of haemodynamic changes in the perioperative setting, and changes in aortic blood flow agree well with corresponding changes in cardiac output intermittently obtained by thermodilution cardiac output measurements. With the combined echo-Doppler technique a proper position of the Doppler beam is greatly facilitated by the M-mode echo visualisation of the aortic wall and aortic cross-sectional area is continuously measured.