Canadian Anaesthetists' Society journal
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Comparative Study
Incentive spirometry: its value after cardiac surgery.
Treatment with intermittent positive pressure breathing (IPPB) and incentive spirometry (I. S.) was compared in 109 patients after heart surgery with cardiopulmonary bypass. Assessment was done by measurement of vital capacity, arterial oxygen tension and identification of the radiological signs of atelectasis. ⋯ P. B., in preventing atelectasis after open-heart surgery. Possibly incentive spirometer treatment given more frequently may be more effective.
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Two cases are presented in which a test dose of bupivacaine 0.75 per cent was injected before institution of an epidural block, as a safeguard against inadvertent intrathecal injection. In each case there was immediate evidence of motor and sensory blockade, which gave warning that the epidural catheter was positioned in the subarachnoid space. The experience of these two cases indicates that bupivacaine 0.75 per cent would be appropriate for use as a test dose in epidural anaesthesia.
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This discussion is based on the experience of the Phoenix Surgicenter, where over 60,000 patients have been anaesthetized since 1970. Patients accepted for out-patient surgery are ASA Status I or II, although status III patients may be included if their co-existing disability is under excellent control. Eighty-five per cent of adult patients receive general anaesthesia. ⋯ Efforts during recovery are directed towards preparing the patient for discharge in a "home ready" condition for safe handling by attending relatives. The common complications have been postoperative nausea or emesis and hypotension. The hospital transfer rate has been 0.2 per cent.
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A study was undertaken on dogs to find the limit of carbon dioxide exchange with high frequency jet ventilation using a fluidic logic controlled oxygen jet ventilator. Fifteen dogs were ventilated through a transtracheal catheter at respiratory rates up to 600 per minute. The following were recorded: aortic, pulmonary artery, pulmonary arterial wedge, and central venous blood pressures; intratracheal pressure, electrocardiogram; inspiratory and expiratory time of the jet; arterial and central venous blood gases; intermittent cardiac output. ⋯ High frequency jet ventilation was then started at a rate of 600 per minute and decreased in increments to 100 per minute. Arterial blood gases were continuously recorded through an intra-arterial catheter connected to a mass spectrometer. The PaCO2 gradually declined to normal levels as the rate decreased.