Revista española de anestesiología y reanimación
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Rev Esp Anestesiol Reanim · Nov 1994
Review[Prevention of cross contamination, patient to anesthesia apparatus to patient, using filters].
Concern for cross infections from patient to patient via apparatus is particularly relevant today. There are several ways to prevent patient contamination through anesthetic devices. Although there is no clinical evidence for using one alternative over another and each hospital establishes its own hygienic protocols, we have introduced the systematic use of filters with patients undergoing general anesthesia. ⋯ We describe three basic physical tests (passage of water, passage of smoke and increase of resistance when applied to the patient) for filters to be classified. The ideal filter is hydrophobic and does not increase circuit resistance over the amount specified. Four principles are emphasized in the protocol: 1) the filter forms a part of the patient, not the apparatus; 2) proper placement of the filter is between the patient and the circuit's "Y" piece; 3) the main purpose of the filter is to prevent contamination of the apparatus, and 4) if a hydrophobic filter is used with each patient, the use of a disposable respiratory circuit is not called for.
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Rev Esp Anestesiol Reanim · Nov 1994
Comparative Study Clinical Trial[Acute respiratory failure in chronic obstructive lung disease. Effective weaning and excess base].
To establish whether the weaning from assisted mechanical ventilation (AMV) should be accompanied by continuous respiratory support (synchronized intermittent mandatory ventilation [SIMV]) or discontinuous support (O2 in T) in patients affected by chronic obstructive lung disease (COLD) who are recovering from acute respiratory failure (ARF), and also to identify any possible predictive value of gasometric measurements. Sixteen patients with COLD and ARF were studied prospectively during their stay in the intensive care unit. Ten had acute bronchitis, 3 had left ventricular failure and 2 had pneumonia. ⋯ When weaning was well tolerated, pH decreased significantly due to an increase in PaCO2 with both techniques, while base excess (BE) remained stable. Values of pH also decreased significantly when weaning was poorly tolerated, and the fall was greater with SIMV; increases in PaCO2 were similar, but decreases in BE were significant. When pH is kept within normal range by a high BE, the withdrawal of AMV, accompanied by either support system, is usually well-tolerated.
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Rev Esp Anestesiol Reanim · Nov 1994
Editorial Biography Historical Article[Rest in peace, teacher and friend. John J. Bonica].
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Rev Esp Anestesiol Reanim · Nov 1994
Clinical Trial[Analysis of induction with 5% isoflurane and 60% nitrous oxide in premedicated adults].
To analyze rapid inhalatory anesthetic induction in premedicated adults (fentanyl, droperidol, diazepam and atropine) with an inspired mixture of O2, N2O (60%) and 5% isoflurane as a means for accelerating induction time and reducing complications. ⋯ Rapid induction with 5% isoflurane is achieved within 1.5 min, with a 20% incidence of coughing and a 5% incidence of mask refusal. The high frequency of apnea (77%) is caused by the rapid elevation of alveolar isoflurane, which has an impact on the apneic threshold. Anesthetic induction with 5% isoflurane and 60% nitrous oxide in premedicated adults is accomplished with good maintenance of hemodynamic stability. However, tachycardia and arterial hypertension appear after laryngoscopy and tracheal intubation.