Acta anaesthesiologica Scandinavica. Supplementum
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Using SHFJV in combination with the jet laryngoscope it is possible to ventilate patients for laryngeal surgery with out the necessity for any kind of endotracheal tube or catheters. This technique can also safely be applied in patients with underlying pulmonary or cardiac disease or in obese patients. ⋯ The SHFJV can be used for tracheobronchial stent insertion. Only in cases were the glottis can not be visualized through the jet laryngoscope sufficient ventilation is not ensured and therefore transtracheal high frequency ventilation is the technique of choice.
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Acta Anaesthesiol Scand Suppl · Jan 1996
Case ReportsHigh frequency ventilation techniques in ARDS.
High frequency ventilation techniques are not applied as routine measures but are still regarded as lastditch efforts in treating patients with severe ARDS or with extensive bronchoplural fistula when conventional mechanical ventilation is not capable in providing sufficient gas exchange. High frequency ventilation techniques can be used in patients with septicemia or recent cerebral bleeding, which is a contraindication for ECMO, or in patients with increased ICP. We believe that high frequency ventilation techniques provide an important therapeutic tool in the treatment of pulmonary insufficiency since the hardware requirement is minimal and, after a brief explanation, the application is easy.
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Acta Anaesthesiol Scand Suppl · Jan 1996
Thermoregulatory vasoconstriction and perianesthetic heat transfer.
Heat transfer between the core and its environment in normothermic and slightly hypothermic situations is determined largely by the influence of vasomotion on convection. Tonic vasoconstriction, the normal barrier to heat loss from the core, is impaired upon induction of anesthesia. The resulting dilation of the arteriovenous shunts leads to redistribution of heat from the core to the periphery, diminishing the temperature gradient between the two compartments. ⋯ Under normal conditions of mild thermal stress, thermoregulatory vasoconstriction is thus able to protect core temperature by reducing cutaneous heat transfer and functionally isolating the peripheral and core thermal compartments. Consequently, anesthetic-induced alterations in vasomotor tone is one of the major factors influencing core temperature in patients who are not actively cooled or warmed. In contrast, thermoregulatory tone is insufficient to prevent core temperature perturbations in patients undergoing vigorous cutaneous cooling or warming.
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Despite minor daily and monthly cyclical variations, body temperature remains relatively constant. Core temperature is maintained by thermoregulatory responses such as sweating, vasoconstriction and shivering, which are largely controlled by the hypothalamus. Within the hierarchy of neural structures regulating autonomic thermoregulatory responses, the preoptic area of the anterior hypothalamus plays a dominant role. ⋯ The increasing phase of fever is often associated with shivering, which can markedly increase heart rate and cardiac output. Defervescence (and passive hyperthermia) is also often accompanied by tachycardia resulting from active precapillary vasodilation. Thus, cardiovascular complications are common throughout the febrile course and constitute the major clinical consequence of fever.