Articles: respiratory-distress-syndrome.
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Acta Obstet Gynecol Scand · Jan 1981
Neonatal depression after obstetrical analgesia with pethidine. The role of the injection-delivery time interval and of the plasma concentrations of pethidine and norpethidine.
Pethidine (100 mg) was administered i.m. to women in labor at different times before delivery. The interval before respiration in the newborn became sustained was shorter if pethidine was given less than one hour before delivery. The respiratory rate of the newborn increased after naloxone injection in 40 per cent of the cases, mostly when intrauterine exposure to pethidine exceeded one hour. ⋯ This correlated with the clinical finding of maximal neonatal depression 2-3 hours after maternal injection. The concentrations of norpethidine increased with a longer time interval between injection and delivery, but were probably too low to have any effect on the newborn. Neonatal depression seems to be related to the amount of unmetabolized pethidine that has been transferred from mother to fetus but not to norpethidine as had been suspected earlier.
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This study evaluates the effectiveness of combining mechanical ventilation and 5 cm H2O positive end-expiratory pressure (PEEP) at the onset of adult respiratory distress syndrome (ARDS) in dogs. Five cm H2O PEEP applied at the onset of ARDS in oleic acid injured dogs resulted in a decrease in cardiac output (CO). ⋯ Control group dogs (receiving mechanical ventilation only) showed a less dramatic changing in CO, but demonstrated a dramatic drop in saturation, compromising oxygen transport of the tissues. Thus, despite decrease in CO experienced by the PEEP group, oxygen extraction at the tissue level remained high.
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The circulatory and acute generalized failure of the circulation, in particular of the lesser peripheral circulation, and may possibly but not necessarily be accompanied by a decrease in blood pressure and damage to the tissue due to a lack of oxygen. The main question concerning the causal pathogenesis of shock is still unsettled, but an interaction between a lack of oxygen as well as of other factors, like endotoxin, complements and vasoactive amines, and the presence of a microthrombosis must be held responsible for the appearance of this condition. In modern intensive medicine the lung must be considered as the preferential area for the manifestation of shock. ⋯ The pathology of shock lung shows two phases and has its onset in exudative alveolitis followed by alveolar fibrosis which can be hardly be controlled by therapy. The early phase of shock lung manifesting itself by exudative alveolitis is decisive with regard to diagnosis and further therapeutic measurements. If the condition can be brought under control at this stage there is a chance that the patient may survive.