Rinshō kyōbu geka = Japanese annals of thoracic surgery
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IVOX was named as an acronym for intravascular oxygenator. The device does not need a blood pomp like an extracorporeal membrane oxygenator (ECMO), and performs intracorporeal gas exchange to be a small elongated, hollow fiber membrane oxygenator designed to lie within the subject's venae cavae so that circulating venous blood can flow freely over and around the external surfaces of the hollow fibers. The amount of gas exchange in IVOX is less than ECMO, however, the equipment is simple and there is no effect to hemodynamics and body temperature. ⋯ Currently the gas transfer rate by means of the IVOX device constitutes 1/4 to 1/3 the total metabolic requirement of adult acute respiratory failure patients. Therefore, intentional hypoventilation to limit airway pressures (mild permissive hypercapnia) is recommended to improve CO2 removal with increasing mixed venous CO2 concentrations. In the future, improvements of design, function, and methods of utilization of IVOX device are expected to increase the amount of gas exchange and to enlarge the indications for its use.
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of propofol on systemic vascular resistance during cardiopulmonary bypass: a comparative study with thiopentone.
30 patients undergoing elective coronary artery bypass grafting surgery were allocated randomly to receive either propofol--2.5mg/kg--(N = 10, Group I) or thiopentone--4mg/kg--(N = 10, Group II) during cardiopulmonary bypass with constant pump flow and temperature. Two groups and another control group-receiving no medication-(N = 10, Group III) were compared with respect to the changes in hemodynamic parameters, especially systemic vascular resistance (SVR). After propofol, SVR decreased from 2489 +/- 302 to 1594 +/- 286 dyn sec cm-5 and remained significantly less than the control values until 16.6 +/- 4 min. after the administration of propofol. ⋯ There were more significant decreases in especially cardiac index, perfusion pressure and SVR in the propofol group compared with thiopentone or control groups. Cardiopulmonary bypass has been shown to be a useful model for studying the isolated effects of anesthetic drugs on hemodynamic parameters. In our study, we tried to discuss the mechanism of the hypotensive effects of anesthetic agents, especially propofol and give an idea about the possible precautions that should be taken.
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In 1970s, survival rate in patients undergoing extracorporeal membrane oxygenation (ECMO) for acute respiratory failure was some around 10% even in sophisticated institutions. Most of them were treated by veno-arterial bypass along with mechanical ventilation with high air way pressure. Problems seen in this treatment modality were; difficulty in controlling bleeding and superimposed infection, mechanical problems of equipment (membrane lung, pumps, bypass circuit etc.), inadequate understanding of pathophysiology of respiratory failure. ⋯ Successful cases are seen in younger patients with short duration of respiratory failure with reversible lung diseases. Bypass time is shorter in successful cases than that in unsuccessful cases. ECMO has revisited as Bartlett says.
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A 18-year-old female, who had incomplete transection of the left main bronchus and laryngeal fracture, due to blunt trauma, is reported. Chest X-ray on admission showed subcutaneous emphysema extending to the cervical soft tissues and marked pneumomediastinum. ⋯ A week later, bronchoscopic reexamination revealed tracheal stenosis just below the vocal cord, due to fracture of the cricoid and thyroid cartilages, which was enlarged to a certain extent by laryngoscopic intervention under cooperation of the laryngologist. The patient's postoperative course was uneventful, and two months later, was well with tracheostomy.