Masui. The Japanese journal of anesthesiology
-
Although internal jugular vein cannulation is performed commonly, most physicians are not aware of existence of the internal jugular venous valve. This is the only valve between the right atrium of the heart and the brain, and it has an important role of preventing retrograde blood flow and increased back pressure to the brain. In this study, anatomic appearance of human internal jugular valves is described, and the competence of these valves is assessed. ⋯ The opening and closing of the valve were easily visualized with both superfine fiberscope and real-time ultrasound technique. Patients with competent valves showed transvalvular pressure gradients of 50-100 mmHg during cough-induced high intrathoracic pressure. Internal jugular venous valve is located 0.5-2.0 cm above the union of the subclavian and internal jugular veins, and the central approach performed at the summit of the cervical triangle has been shown to have a risk of injuring the internal jugular venous valve.(ABSTRACT TRUNCATED AT 250 WORDS)
-
We studied the protective effect of prostaglandin E1 (PGE1)-induced hypotensive anesthesia on gastric mucosa in 30 elective surgical patients. Three groups, each composed of 10 patients, received PGE1, nitroglycerin or none during general anesthesia. ⋯ In the PGE1 group the viscosity and pH increased significantly and rapidly (P less than 0.05) as compared with the other groups. This suggests that PGE1 offers prophylactic effect against postoperative acute gastric mucosal lesion (AGML).
-
We experienced troubled endotracheal intubation in an adult patient with asymptomatic tracheal bronchus. The breath sounds of the right upper lobe were found to be absent right after the placement of a tracheal tube. ⋯ In a patient with this anomaly, who is otherwise healthy, a placement of a tracheal tube may cause pulmonary complications. Thus, as a diminished breath sound is found to be located at the upper right lobe after endotracheal intubation, we have to think of tracheal bronchus as one of the possible causes.
-
An open circuit tracer gas washout method for measurement of functional residual capacity (FRC) during mechanical ventilation is described and tested. The system employed a piezo-valve for dispensing sulfur hexafluoride (SF6) gas, a fast response infrared SF6 analyzer, Servo 900-C ventilator and a computer. The piezo-valve unit delivers SF6 into the airway in proportion to instantaneous inspiratory flow so that inspiratory SF6 concentration was held constant regardless of the inspiratory flow pattern. ⋯ Comparison with helium dilution methods in 24 healthy subjects gave a regression equation: y = 0.98x + 56, r = 0.98. The mean difference of the values between the two methods was 21 +/- 142 ml (M +/- 2SD). The authors conclude that the system is quite useful in determining FRC of the patients under mechanical ventilation.
-
The authors have developed an ECPB system, which can be applied quickly, safely and easily under an emergency condition requiring cardiac massage and artificial ventilation. Fundamentally, the ECPB system consists of 3 parts; a portable ECPB apparatus, a pair of percutaneous cannulae and a short circuit connecting an oxygenator with the cannulae. The ECPB apparatus is assembled with commercially available components (i.e., a centrifugal pump, a battery pack, a temperature controller, a compact membrane oxygenator with a heat exchanger, etc) and they are placed on a mobile cart. ⋯ The tip of the venous cannula is adjusted to be placed near the right atrium under fluoroscopy. Initiation of ECPB via the femoro-femoral V-A cannulae assures instant and stable supply of oxygenated blood to all of the vital organs. At the present time, nothing is more important than a quick supply of oxygenated blood to the brain to ameliorate the post-ischemic brain damage.