Respiratory Care in Guillian Barre' Syndrome / 대한마취과학회지

Guillian-Barre syndrome may result in severe pulmonary insufficiency and death. Four cases disgnosed as this syndrome were treated with respirators such as Bird Mk-7, Bennett PR-Z, Bennett MA-1 and Ohio-560. All of the patients were tracheostomized and had a cuffed tracheostomy tube inserted. Volume and pressure respirators were fixed according to vital signs and arterial blood gas tensions. Mechanical and ultrasonic nebulizer and a heated humidifier were used for humidification. Lung vibration, postural drainage and breathing exercises were performed as occasion required. To prevent cross-infection aseptic techniques were used far tracheal suction and the sterilizable parts of the respirator and tracheostomy tube were changed daily. During the weaning from the respirator the vital signs, lung volumes and blood gas tensions with pH were carefully observed. Duration of respirator uses were 19 to 79 days and thereafter all were improved without complications. The results were as follows; 1. In 3 of 4 cases pseudomonas aeruginosa were cultured in sputum. 2. Narcosis, due to hypercapnea, and atelectasis were observed in case 1 and 2. 3. Electrolytes remained within normal limits in all cases. 4. The period of complete weaning from respirators required 4 to 30 days. 5. Bennett MA-1 and Ohio-560 respirators were more convinient than pressure limited respirators for humidification and regular deep breathing.

Experimental Study of FIydroxyethyl Stareh as a New Plasma Expander / 대한마취과학회지

Since 1957 clinical studies and animal experiments have reported that a solution of hydroxyethyl starch in saline (HES) was effective as a plasma expander. We have studied hydroxyethyl starch as compared to dextran after experimental bleeding. Thirteen dogs averaging 10 kg body weight were utilized in this study. Without premedicants anesthesia was induced with intravenous thiopenthal sodium and subsequently endotracheal intubation was performed. Respiration was controlled with a Harvard Pump, setting the respiratory rate at 15 times a minute and tidal volume at 20 ml/kg. Arterial blood pressure, central venous pressure and EKG lead II were recorded by polygraph. RIHSA was used for the measurement of plasma volume and extracellular volume. Experimental bleeding was equalled 25ml/kg for 15 minutes and the same amount of plasma expander (HES or Dextran) was infused 30 minutes after bleeding. The results were as follows: 1. Blood pressure was markedly decreased after experimental bleeding, but on administration of HES or Dextran it returned to nomal values. In the control group blood pressure persisted at about 90 mmHg. Central venous pressure after the administration of HES or Dextran also recovered to the level before bleeding. Pulse rate was slightly decreased after infusion of plasma expanders. 2. The values of hemoglobin and hematocrit were reduced about 40 percent after infusion of HES or Dextran. 3. Plasma volume was increased about 130 percent and blood volume was increased about 110 percent immediatly after infusion of HES or Dextran. A significant change in ECF could not be observed. 4. A persistent dilutional acidosis after infusion of HES or Dextran was not found. 5. In the HES or Dextran groups osmotic diuresis was observed. In the results of our experimental study no significant differences between HES and Dextran were observed, and it is thought that HES is safe and useful as a plasma expander.