Journal of clinical monitoring
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Two commercially available complete anesthetic simulators were studied in the United States. Although there are some differences between the two systems, each consists of an adult manikin allowing some direct anesthetic interventions, a system of producing physiologic signals to any commercial monitoring system, and the ability to interface with an anesthetic machine and ventilator. In addition, both simulators model the responses to a variety of drugs used by anesthetists. ⋯ Now available are combined systems using manikins controlled by computer, with interfaces to anesthetic machines, ventilators, and monitoring equipment. Two systems are commercially available in the United States. In this report, we briefly describe their technical specifications and how we saw them being used.
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The mechanical properties of the respiratory system (i.e., elastance and resistance) depend on the frequency, tidal volume, and shape of the flow waveform used for forcing. We developed a system to facilitate accurate measurements of elastance and resistance in laboratory and clinical settings at the frequencies and tidal volumes in the physiologic range of breathing. ⋯ Accurate, standardized measurements of lung and chest wall properties can be obtained in many settings with relative ease with the system described. These properties, and their frequency and tidal volume dependences in the physiologic range, provide important information to aid in the understanding of changes in respiratory function caused by day-to-day conditions, clinical intervention and pathologies.
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In this study, we evaluated the usefulness of end-tidal oxygen monitoring during intratracheal jet ventilation (ITJV) for endolaryngeal laser surgery. ⋯ ETO2 concentration should be maintained well over 21% during ITJV to prevent alveolar and arterial hypoxia. Monitoring of respiratory oxygen concentrations at jet cycle rates of 20 cycles/min and less verifies safe oxygen levels during laser surgery, and confirms adequate alveolar oxygenation.
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Our objective was to determine if rebreathing would reduce the gradient between arterial and end-tidal CO2 tension during positive-pressure ventilation. ⋯ Rebreathing with a Mapleson D circuit and a VF equal to VA permitted normal CO2 elimination. Arterial PCO2 to PECO2 gradient decreased significantly during rebreathing, thus improving the reliability of capnography for estimating arterial PCO2. Consideration should be given to using the Mapleson D as a rebreathing circuit.