Clinical effect of low-flow oxygen combined with fosinopril on treatment of acute plateau heart disease / 解放军医学杂志

[Abstract] Objective To study the therapeutic effect and responding time of low-flow oxygen combined with fosinopril on treatment of acute plateau heart disease. Methods Ninety young male officers and soldiers, diagnosed as acute plateau heart disease after rushing into the plateau (Ali region of Tibet, 4300 m) from the plain area and admitted to the Shiquanhe Medical Station in Ali Military Division from Sep. 2017 to Apr. 2018, were recruited in present study. All the subjects were randomly divided into 3 groups: group A were treated with low-flow oxygen (2 L/min, 60 min, twice a day), group B were treated with fosinopril (10 mg/d), and group C were treated with low-flow oxygen (2 L/min, 60 min, twice a day) combined with fosinopril (10 mg/d). Echocardiography was performed 2, 4 and 6 weeks after treatment to detect the pulmonary artery inner diameter (PAD), inner diameter of right outflow ventricular tract (ROVT), mean pulmonary arterial pressure (MPAP) and right ventricular Tei index (RV-Tei), the test results were then compared among the 3 groups to evaluate the therapeutic effect. Results Two weeks after treatment, the PAD, ROVT, MPAP and RV-Tei in group C [(21.66±3.49) mm, (25.81±2.33) mm, (22.37±2.78) mmHg and (0.24±0.05)] were significantly lower than in group A and group B [(28.37±3.75) mm and (27.29±2.91) mm; (31.25±5.27) mm and (30.34±5.66) mm; (28.25±4.17) mmHg and (27.11±4.94) mmHg; and (0.33±0.08) and (0.32±0.05)] with statistical differences (P0.05). Four weeks after treatment, the PAD, ROVT, MPAP and RV-Tei in group B and group C [(22.21±1.76) mm and (21.17±1.97) mm; (25.29±3.71) mm and (24.30±1.99) mm; (23.91±2.63) mmHg and (21.03±3.17) mmHg; and (0.23±0.06) and (0.23±0.05)] were significantly lower than in group A [(25.09±3.75) mm; (29.38±3.06) mm; (27.87±3.71) mmHg; and (0.29±0.05)] with statistical differences (P0.05). Six weeks after treatment, for PAD, ROVT, MPAP and RV-Tei no significant difference existed among group A, group B and group C [(22.71±2.86) mm, (21.29±2.56) mm, (20.39±2.03) mm; (24.08±3.51) mm, (23.15±3.08) mm, (23.02±2.31) mm; (23.42±1.79) mmHg, (22.88±2.77) mmHg, (21.72±2.49) mmHg; and (0.23±0.04), (0.22±0.06), (0.22±0.06)], and all the measured values reached normal level. Conclusion Low-flow oxygen combined with fosinopril therapy is more effective in curing acute plateau heart disease, and in preventing right heart failure caused by plateau heart disease.

Estenosis aórtica severa de bajo flujo, bajo gradiente con función sistólica preservada, un reto diagnóstico y terapéutico: ¿qué sabemos a día de hoy? / Low-flow, low-gradient severe aortic stenosis with preserved systolic function, a diagnostic and therapeutic goal: What do we know today?

Resumen La estenosis aórtica severa de flujo bajo, gradiente bajo y la fracción de eyección del ventrículo izquierdo conservada es una entidad frecuente en la práctica clínica. Probablemente, represente una fase más avanzada de la enfermedad con una mayor carga soportada o de más larga data y con una fisiopatología restrictiva. Existen características clínicas, hemodinámicas y ecocardiográficas típicas. Se trata de una entidad infradiagnosticada y como consecuencia infratratada con un claro peor pronóstico con tratamiento conservador. Se necesita en muchos casos el apoyo de la «multiimagen¼ para un adecuado diagnóstico y elección del momento terapéutico. La sustitución valvular en los pacientes con estenosis aórtica severa y flujo bajo paradójico, parecen tener una mayor mortalidad a corto y largo plazo al compararla en los pacientes con flujo normal y similar si lo hacemos frente a la estenosis aórtica de bajo flujo y fracción de eyección del ventrículo izquierdo deprimida. Existe una menor mortalidad con la implantación transcatéter de válvula aórtica comparándolo frente al tratamiento médico en pacientes con estenosis aórtica severa sintomática con flujo bajo, tanto la fracción de eyección baja como el flujo bajo paradójico, considerados inoperables. No parecen existir evidencias actuales para recomendar el abordaje percutáneo frente al recambio valvular aórtico quirúrgico en los pacientes de alto riesgo quirúrgico con estenosis aórtica con flujo bajo paradójico.

Abstract Low-flow, low-gradient severe aortic stenosis with preserved ejection fraction of the left ventricle is a frequent entity of clinical practice. It can probably represent a more advance phase of the illness with a heavier load or time frame and a restrictive pathophysiology. There are typical clinical, hemodynamic and echocardiographic characteristics. It is an underdiagnosed condition, and as such it is undertreated, with a clearly worse prognosis with conservative treatment. In many cases, the help of «multiimaging¼ is required for an appropriate diagnosis and choosing the therapeutic moment. Valve replacement in patients with paradoxical low-flow, low-gradient severe aortic stenosis seem to show higher mortality in the short and long term when compared to patients with normal flow, and similar mortality if compared to low-flow aortic stenosis with depressed ejection fraction of the left ventricle. There is a lower mortality with the transcatheter aortic valve implantation in comparison with treatment of patients with symptomatic low-flow severe aortic stenosis, both for a low ejection fraction and for the paradoxical low flow, considered inoperable. No current evidence seems to exist to recommend percutaneous approach versus aortic valve replacement in high surgical risk patients with aortic stenosis with paradoxical low flow severe aortic stenosis.

Mega Acer Kit® is more effective for warming the intravenous fluid than Ranger™ and ThermoSens® at 440 ml/h of infusion rate: an experimental performance study / 대한마취과학회지

BACKGROUND: Few studies have investigated the effectiveness of intravenous fluid warmers at low and moderate flow rates below 1,000 ml/h. In this study, we compared the effectiveness of three different fluid warmers at a low flow rate (440 ml/h). METHODS: We experimentally investigated the fluid warming performances of Mega Acer Kit® (Group M, n = 10), Ranger™ (Group R, n = 10), and ThermoSens® (Group T, n = 10) at 440 ml/h for 60 min. All devices were set at a warming temperature of 41℃ with preheating for 10 min. Intravenous fluids were then delivered through them. The fluid temperature (primary endpoint) was measured at 76 cm from the device after infusion for 60 min. The expected decrease in mean body temperature (secondary endpoint) after 5 h infusion for a 70 kg patient (ΔMBT5) was also calculated. RESULTS: The fluid temperature (mean [95% CI]) at 76 cm from the device, 60 minutes after the infusion was higher in group M (36.01 [35.73–36.29]℃), compared to groups T (29.81 [29.38–30.24]℃) and R (29.12 [28.52–29.72]℃) (P < 0.001). The ΔMBT5 (mean [95% CI]) was significantly smaller in group M (−0.04 [−0.04 to −0.03]℃) than that in groups T (−0.27 [−0.28 to −0.29]℃; P < 0.001) and R (−0.30 [−0.32 to −0.27]℃; P < 0.001). However, none of the fluid warmers provided a constant normothermic temperature above 36.5℃. CONCLUSIONS: Mega Acer Kit® was more effective in warming the intravenous fluid with the smallest expected change in the mean body temperature, compared to Ranger™ and ThermoSens®, at a flow rate of 440 ml/h.

Diagnosis and Treatment of Low-flow Priapism (Report of 35 Cases) / 现代生物医学进展

Objective:To discuss the diagnostic approaches and treatment choices of low-flow priapism.Methods:35 cases of patients suffered from the low-flow priapism in our hospital from September 2010 to October 2016 were selected and diagnosed with the low-flow (ischemic) priapism by combining cavernous blood gas analysisand and color duplex ultrasonography.The priapism lasted 12 to 240 h with a mean of 72 h.31 patients of them had ever been induced by Polysaccharide Sulfate.One appeared priapism after sexual life.One appeared priapism after micturition.2 of them were not known what drug they had taken.Results:The symptoms disappeared in 5 cases as a result of using cold compress,sedation method and intracavemous lavage in hospital.But 30 cases were still priapism.Their penis were in a flaccid state after they were performed with the operation of glandular cavemosum shunting.During the 6-24 months of follow-up,31 patients developed erectile dysfunction.Among them,13 cases were light to mid erectile dysfunction,10 cases were mildly and 8 cases were the worst.Conclusion:(1) Using cavernous blood gas analysis and color duplex ultrasonography is important way to diagnose priapism.(2) Cold compress,sedation method and intracavemous lavage are the first treatments for the the low-flow priapism.If they are not the effectual cure,the operation of glandular cavemosum shunting should be performed in time.

Orbital infarction syndrome after multiple percutaneous sclerotherapy sessions for facial low‑flow vascular malformation: A case report and literature review.

Vision loss following sclerotherapy for facial vascular malformations (VMs) is a rare but detrimental complication. Here, we report a case of an 11‑year‑old boy with acute onset blepharoptosis, ophthalmoplegia, and blindness in his right eye after the 14th sclerotherapy session (percutaneous intralesional injection of sodium tetradecyl sulfate) for a right facial low‑flow VM without orbital involvement. Computed tomography angiography revealed no contrast enhancement in the right ophthalmic artery, superior ophthalmic vein, or extraocular muscles. He presented with the hallmarks of orbital infarction syndrome: Clear signs of anterior and posterior segment ischemia and disrupted arterial flow to the extraocular muscles. His blepharoptosis and eye movement improved 4 months later; however, he remained blind, and phthisis bulbi developed eventually. Thus, sclerotherapy for facial VM—even without orbital involvement––may result in severe ocular and orbital complications.

Malformación vascular de bajo flujo sinovial de la rodilla (hemangiolinfangioma): Reporte de caso / Low-low synovial vascular malformation of the knee (hemangiolymphangioma): Case report

Introducción: La malformación vascular venosa de bajo lujo se desarrolla generalmente durante la primera infancia y puede ser una causa poco frecuente de derrame recurrente de larodilla. La clínica, las pruebas de laboratorio y las radiografías suelen ser inespecíficas. Objetivo: Describir una patología infrecuente en pediatría, para enfatizar en la correcta clasificación y sospecha. Caso Clínico: Paciente de 2 años con historia de episodios de derrame articular de la rodilla derecha que requirió múltiples hospitalizaciones y tratamientos antibióticos. Exámenes de laboratorio normales. La radiografía simple de la rodilla no mostró cambios óseos. La resonancia magnética reportó malformación vascular de bajo lujo. Se realizó resección quirúrgica que evidenció lesión vascular entre las fibras musculares del vasto lateral del cuádriceps con extensión hasta la cápsula de la rodilla y disección de las fibras hasta el vasto lateral de la pierna derecha. El estudio histológico fue compatible con malformación vascular de bajo lujo. Ante el hallazgo benigno y la evolución favorable, continuó con tratamiento ambulatorio. Conclusiones: Aunque la malformación vascular de bajo lujo sinovial es una patología poco frecuente en la población pediátrica, debería considerarse la realización de un diagnóstico diferencial en pacientes con aparición repetida de hemartrosis sin historia de coagulopatía ni hemofilia.

Introduction: Low-low vascular malformation, which usually develops during the first stage of infancy, is a rare cause of recurrent effusion of the knee. History, laboratory and X-rays are usually non-specific. Objective: To describe a rare disease in pediatrics, emphasizing the correct classification and suspicion. Case Report: A case is presented of a two-year-old patient with a history of effusion of the right knee who required multiple hospitalizations and antibiotic treatments. Laboratory work-up was normal. Plain X-rays of the knee revealed no bone changes. MR imaging reported low-low vascular malformation. Surgical resection was performed, evidencing vascular lesion among the muscle fibers of the vastus lateralis of quadriceps until the capsule of the knee, as well as dissection of the fibers until the vastus lateralis of the right leg. Histology was consistent with low-low vascular malformation. Due to the benign outcome and favorable evolution, an outpatient management was possible. Conclusions: Although low-low synovial vascular malformation is a rare disease among the pediatric population, it should be considered in the differential diagnosis of patients with repeated hemarthrosis and no history of either coagulopathy or hemophilia.

Retrospective Analysis of Two Low-flow Anesthesia Drugs for Pediatric Laparoscopic Operation / 中国药房

OBJECTIVE:To evaluate therapeutic efficacy and safety of two low-flow anesthesia drugs for pediatric laparoscop-ic surgery. METHODS:72 children underwent laparoscopic surgery in our hospital during Jan. 2012 to Dec. 2014 were collected retrospectively,and divided into trial group and control group,with 36 cases in each group. According to body weight,trial group was given sevoflurane 0.1 mg/kg and oxygen flow rate 0.6 L/min for anesthesia before surgery. The anesthesia induction time,AP, HR,SpO2 and pEtCO2 before surgery,during anesthesia induction and maintenance of anesthesia and at the end of surgery,recov-ery time,extubation time,dysphoria,nausea and vomiting after awake up were compared in 2 groups. RESULTS:Compared with before anesthesia,AP,HR and pEtCO2 of 2 groups were increased significantly,with statistical significance(P0.05). HR,AP and pEtCO2 of trial group were lower than those of control group after pneumoperitoneum,with statistical significance(P<0.05). After operation,recovery time,extubation time and the proportion of dysphoria in trial group were shorter or lower than control group, with statistical significance (P<0.05). CONCLUSIONS:The sevoflurane anesthesia has little effect on blood pressure and HR of patients,has short recovery time and extubation time,little side effects and good clinical efficacy.

Effects of inhalation anesthesia with low-flow sevoflurane on renal function of neonates / 中华麻醉学杂志

Objective To evaluate the effects of inhalation anesthesia with low-flow sevoflurane on the renal function of neonates.Methods Forty ASA physical status Ⅰ or Ⅱ neonates undergoing abdominal surgery under general anesthesia,aged 6-28 days,weighing 1730-2928 g,were included in the study.After induction of anesthesia,anesthesia was maintained with sevoflurane inhalation using a semi-closed circuit system (FGF 1 L/min).The end-tidal concentration of sevoflurane was maintained at 2.5％-4.0％ according to the vital signs.Before induction of anesthesia,immediately after operation,and at 24,48 and 72 h after operation,blood samples from the peripheral vein and urine specimens were taken for determination of serum concentrations of creatinine (Cr),blood urea nitrogen (BUN),urinary retinol binding protein (RBP) and β-N-acetyl-glucosaminidase (NAG).A temperature probe was inserted to the center of soda lime canister.Results Compared with the baseline value at T0,no significant changes were found in the serum Cr and BUN concentrations at T1-4,urinary RBP concentrations were increased at T1,no significant changes were found in urinary RBP concentrations at T2-4,NAG concentrations were significantly increased at T2 and no significant changes were found in NAG concentrations at T1,3,4.The temperature of soda lime was (37 ± 3) ℃ at the end of operation.Conclusion Inhalation anesthesia with low-flow sevoflurane (FGF 1 L/min) produces no significant effect on the renal function of neonates.

Development of Nursing Practice Guidelines for Non-humidified Low Flow Oxygen Therapy by Nasal Cannula / 간호행정학회지

PURPOSE: The purpose of this study was to provide a basis for non-humidified low flow oxygen by nasal cannula and to provide a guide for consistent care in nursing practice. METHODS: A methodological study on the development of guidelines with experts' opinions on collected items, framing PICO questions, evaluating and synthesizing texts which were searched with the key words (low flow oxygen, nasal cannula, humidification of oxygen, guideline) from web search engines. RESULTS: Of the 45 researched texts on the web, 9 texts relevant to the theme were synthesized and evaluated. All patients with humidified or non-humidified oxygen therapy reported that they had no discomfort. CONCLUSION: The results indicate that there are no tangible grounds for patients' perceived differences between the humidified and non-humidified oxygen under 4L/min supplied by nasal cannula. with oxygen. Therefore, non-humidification oxygen therapy is strongly advised when suppling under 4L/min oxygen by nasal cannula (recommended grade A).

Low-flow anesthesia in children: theory and clinical practice

There has been increased interest recently in low-flow anesthesia to minimize wastage of expensive volatile anesthetics and reduce atmospheric pollution. With the help of modern anesthetic apparatus and the availability of comprehensive gas monitoring, low-flow anesthesia can be performed safely in children. However, pediatric anesthesiologists have been more reluctant to adopt low-flow techniques. In this review article, the safety and efficacy of low-flow anesthesia will be discussed to help the anesthesiologists who want to employ this technique in children.

Bombas de infusión continua de jeringa en unidades neonatales / Continuous infusion pumps at neonatal intensive care units

Introduction: Continuous Infusion pumps (CIP) are frequently used at neonatal intensive care units (NICUs), to administer medications at flow rates lower than 1 ml/H. Various factors have been shown to alter their performance. No studies have been completed in Chile in this area. Objectives: To describe frequent clinical practices to administer medications through CIP at NICUs in Chile, and suggest recommendations about it. Methods: Four professionals at NICUs in 19 centers were surveyed regarding syringe size, flow rate and precautions. Results: When starting countinuous infusion, 81.9 percent of surveyed professionals use 50 cc syringes, and 66.7 percent of them use flow rates under 1 ml/h. Main precautions include elimination of bubbles in the circuit (51.4 percent), review of conections (38.9 percent) and precise fit between the syringe and the CIP (36.1 percent). Conclusions: In surveyed NICUs, low flow rates and 50cc syringes are frequently used to infuse medications. NICU staff must consider factors that affect the performance of CIP, prefer smaller syringes and flow rate over 1 ml/h for continuous infusion of drugs.

Introducción: En las unidades de cuidado intensivo neonatal (UCIN) se utilizan frecuentemente bombas de infusión continua (BIC) a flujos menores de 1 ml/h para administrar medicamentos. Está demostrado que distintos factores alteran el funcionamiento de las BIC a flujos bajos. En Chile, no existen estudios que describan prácticas relacionadas al uso de BIC. Objetivo: Describir prácticas clínicas frecuentes al administrar medicamentos en BIC en UCIN de Chile y proponer recomendaciones respecto a su uso. Método: Se encuestaron 4 profesionales de UCIN en 19 centros. Los principales aspectos evaluados fueron: tamaño de jeringa usado en las BIC, flujos de infusión continua utilizados y precauciones al instalar una BIC. Resultados: Al instalar una infusión continua, el 81,9 por ciento de los profesionales encuestados usa jeringas de 50 ml y el 66,7 por ciento utiliza flujos menores de 1 ml/h. Las principales precauciones fueron la eliminación de burbujas del circuito (51,4 por ciento), la revisión de las conexiones del sistema (38,9 por ciento) y el ajuste preciso entre jeringa y BIC (36,1 por ciento). Conclusiones: En las UCIN estudiadas se utilizan frecuentemente flujos bajos y jeringas de 50 ml para infundir medicamentos. Las UCIN deben considerar los factores que alteran el funcionamiento de las BIC y preferir el uso de jeringas de menor tamaño y flujos mayores de 1 ml/h para la infusión continua de medicamentos.

The effect of low fresh gas flow rate on sevoflurane consumption / 대한마취과학회지

BACKGROUND: In an era of medical cost containment, cost-effectiveness has become a major focus in healthcare. The effect of a new policy on the use of low fresh gas flow during maintenance of general anesthesia with volatile anesthetics was evaluated. METHODS: The numbers and duration of general anesthesia cases using sevoflurane 5 weeks prior to and 15 weeks after policy implementation were retrieved from the electronic medical records database. The number of sevoflurane bottles consumed was also assessed. The anesthesia hours per bottle of sevoflurane were compared before and after policy implementation. RESULTS: The number of anesthesia hours performed per bottle of sevoflurane increased by 38.3%. The effect varied over time and tended to fade with time. CONCLUSIONS: The implementation of a low fresh gas flow rate policy effectively reduces the amount of sevoflurane consumed for the same duration of anesthesia.

Establishment and evaluation of the model of deep hypothermic low flow in young rats / 中华创伤杂志

Objective To investigate the changes of cerebral blood flow and the level of brain injury in a rat model of deep hypothermia low flow(DHLF).Methods Twelve SD rats aged 3 weeks were randomly divided into sham group and model group.Regional cerebral blood flow(rCBF)of all rats was measured continuously during the operation by laser Doppler flowmetry,and the changes of rCBF were measured before temperature decreased,when the temperature decreased to(21.0±0.5)℃,0-5 minutes,25-30 minutes,55-60 minutes,115-120 minutes during DHLF and 0-5 minutes after DHLF operation.Another 60 SD rats aged 3 weeks were randomly divided into sham group and model group.Six rats of each group were sacrificed at 1,6,24,72 hours and 7 days after DHLF operation to detect the pathological changes of the brain and the neuronal apoptosis by HE staining and TUNEL assay.The neurological deficit score(NDS)was recorded at 24,72 hours and 7 days after operation for evaluating the neurologic functional outcome.ResultsWhen the temperature was decreased to(21.0±0.5)℃,the levels of rCBF of sham group and model group were significantly decreased to(41.1±4.2)% and(40.7±3.4)% of the baseline value,and the rCBF level of model group was further decreased to(15.7±3.5)% of the baseline value 0-15 minutes during DHLF(P ＜ 0.01),with no obvious changes in all the time intervals during DHLF.Compared with the sham group,the scores of NDS of model group were significant lower at 24 and 72 hours after operation(P ＜ 0.05 or 0.01).Besides,a significant pathological change of the brain tissue and a increased percentage of TUNEL-positive staining cells were observed in model group at 6,24,72 hours and 7 days after operation(P ＜ 0.01).Conclusions Rat model of DHLF is an ideal and reliable model of brain injury,for it is similar to DHLF procedure of clinical cardiac operation.

Coeficiente de ultrafiltración en dializadores de bajo y alto flujo reusados / Coefficient of ultrafiltration in reused low and high flow dialyzers

El reúso de los dializadores constituye un problema de gran magnitud en nuestro país. Se realizó un estudio observacional, descriptivo, prospectivo para determinar el Kuf de los dializadores de BF y AF reusados. Se estudiaron 8 pacientes en el Servicio de Hemodiálisis del Instituto de Nefrología Dr Abelardo Buch López, durante 18 sem, se utilizaron membranas de BF y AF, durante 2 etapas. El reúso fue automatizado, utilizando como germicida ácido peracético. Se midió Kuf in vitro e in vivo durante todas las hemodiálisis, se realizaron 432 hemodiálisis. El Kuf in vitro e in vivo de ambos tipos de dializadores disminuyó considerablemente en los primeros 6 usos. El Kuf de ambos tipos de dializadores tiene una importante disminución con el reprocesamiento.

Reuse of dialyzers is a serious problem in our country. To perform an observational, descriptive and prospective study to determine the Kuf of reused low-flow (LF) and high-flow (HF) dialyzers. Eight patients were studied in Hemodialysis Service of Dr Abelardo Buch López Nephrology Institute during 18 weeks, using LF and HL membranes in two stages. Reuse was automated using peracetic. acid like germicide. In vitro and in vivo Kuf was measured during all Hemodialysis (431 in total). In vitro and in vivo Kuf of both types of dialyzers decrease significantly during the first six uses. Kuf of both types of dialyzers has an important diminution with re-processing.

Problemas de la alimentación en lactantes. Primera parte: generalidades / Feeding problems in infants. First part: basic concepts

Desde la etapa prenatal, la organización neuro-fisiológica del bebé lo prepara para realizar con efectividad los procesos vitales de succión, deglución y respiración. Los reflejos y experiencias intrauterinas le permitirán poder alimentarse inmediatamente al nacer. Se estima que cerca del término de la gestación, el feto humano deglute entre 500-1000cc de líquido amniótico cada día. El pico de sinaptogénesis sucede entre 34 y 36 semanas de edad gestacional, que es el tiempo donde la succión nutritiva es segura. El ritmo de la succión se establece a las 32 semanas. El proceso de alimentarse sufre encefalización cuando los reflejos son integrados, entonces pasa de un ritmo de alimentación reflejo, a tener la capacidad de alterar voluntaria y cualitativamente la estrategia de alimentación. Este proceso se consolida debido a la integración sensoriomotora de la deglución con la respiración, la coordinación ojo-mano, el tono muscular normal, la postura y un apropiado ambiente psicosocial. Alimentarse, especialmente en los primeros años de vida, es un proceso mutuo, se necesitan dos personas para lograrlo, y por eso, si alguna de las dos carece de las habilidades necesarias, esto puede generar problemas de la alimentación. Nada sustituye la valoración realizada con una historia clínica y un examen físico dirigidos a valorar cuán efectiva es la fase oral y faríngea mientras el bebé es alimentado. Cuando se presenten dificultades, la intervención debe ser activa, eso incluye la toma de decisiones médicas y quirúrgicas, protección de la vía aérea, suministro del aporte calórico idóneo para las necesidades del infante. Se deben además brindar estrategias maduracionales para su nivel de desarrollo alimentario actual y para ir adquiriendo las habilidades esperadas en elfuturo cercano y tardío

Anestesia General balanceada con Flujos bajos / General Aenesthesia balanced with low flow

La anestesia general con flujos bajos, es para nuestro medio una práctica reciente, en cambio en otros países como Es paña y México esta técnica se practica desde la década pasada ya que requiere de modernas maquinas de anestesia, dotadas de circuitos circulares y sistemas de monitorización de gases, monitorización de la ventilación pulmonar, y monitores multiparamétricos de signos vitales (de 6 canales), que han permitido el desarrollo reciente de esta técnica en nuestro medio. El presente estudio tiene como propósito fundamental proponer una nueva técnica que hoy en día es una necesidad para dosificar mejor los anestésicos y proporcionar un mejor margen de seguridad, reducir el riesgo anestésico y por ende administrar una anestesia más segura, efectiva y eficiente a los pacientes, disminuyendo así, la morbilidad posoperatoria de la vía aérea porque proporciona gases húmedos y calientes. La reducción del flujo de gas fresco a 1 litro por minuto (02), nos permite ahorrar tanto 02 como el gas anestésico por lo tanto se reducirán los costos principalmente de los nuevos gases anestésicos cuyo valor es prohibitivo para nuestro medio y al mismo tiempo reduciremos la contaminación de los quirófanos y el medio ambiente.

The general anesthesia with low flow, is for us a recent practice but not in Spain and Mexico, this technique is practiced since ten years ago and require modern anesthesia machines that are equipped with a circle rebreathing system, monitoring of inspiratory and expiratory gas concentrations necessary This project has permitted propose new technique that today is a need to facilitates precise anesthetics administration for the patient. That reduce the anesthetics risks doing a efective, safe and eficient anesthesia but also makes gases more warm and humid reducing the postoperatory morbidity airway patient's. When Fresh Gas Flow is reduced to 1.0 L/min, reduce the costs of volatile anesthetics and provide considerable economic and ecological benefits, but may also improve the quality of patient care

The Effect of Sufentanil on Myocardial Function and Coronary Flow in an Isolated-Heart Rat Model / 대한마취과학회지

BACKGROUND: Some opioids have been shown to attenuate an ischemia-reperfusion injury in an isolated-heart model. The aim of this study was to evaluate the effect of sufentanil on the cardiac function in isolated-heart models when given before and after prolonged periods of low flow ischemia. METHODS: Isolated rat hearts were stabilized for 30 minutes and subdivided into four groups (each n = 7). The control group was subjected to low flow ischemia (LFI 0.3 ml/min) of 5% dextrose water for 30 minutes, followed by perfusion with a modified Krebs solution at a constant pressure for 60 minutes. In the sufentanil groups, different sufentanil (12.5 mg/L, 25 mg/L, 50 mg/L) doses were administered with the modified Krebs solution after 30 minutes of stabilization until the end of the experiment with the exception of the LFI group. The left ventricular end systolic pressure (LVESP), dP/dt max, heart rate and coronary flow were measured. After reperfusion, the infarct size of all groups was measured. RESULTS: The control and the sufentanil groups had a lower LVESP, dP/dt max, coronary effluent flow and arrhythmia duration after ischemia and reperfusion than those before ischemia. The infarct sizes in the sufentanil groups were smaller than those in the control group. However the infarct sizes of the sufentanil groups were similar. CONCLUSION: Sufentanil reduces the infarct size but does not improve the post-ischemic functional dysfunction.

Comparison between High Flow and Low Flow Anesthesia for Positive Pressure Ventilation in Pediatrics Using the Laryngeal Mask Airway / 대한마취과학회지

BACKGROUND: Low flow anesthesia provides many advantages, including reduced cost, conservation of body heat and airway humidity. This study was performed to compare low flow anesthesia with high flow anesthesia and to investigate whether the advantages of low flow anesthesia during positive pressure ventilation can be combined with the laryngeal mask airway in paralyzed pediatric patients. METHODS: Thirty-one pediatric patients of ASA physical status 1 or 2 were studied and divided into two groups according to the fresh gas flow (FGF) in the breathing system; low flow group (FGF approximation 1 L/min, n = 17) or high flow group (FGF approximation 4 L/min, n = 14). Each respiratory parameter was measured when a steady state was reached at 20 min after induction. RESULTS: There were no significant differences of respiratory data between the two groups except that the inspired oxygen concentration was lower in the low flow group than in the high flow group. Hemodynamic changes with the laryngeal mask airway insertion were not statistically significant. CONCLUSIONS: A laryngeal mask airway is an effective airway device for low flow anesthesia as well as for high flow anesthesia in paralyzed pediatric patients.

Clinical Evaluation of Low-Flow Enflurane Anesthesia in Infants / 대한마취과학회지

BACKGROUND: The purpose of this study was to evaluate the safety and efficacy of low-flow anesthesia with a semi-closed circle anesthesia system in infants. METHODS: Twenty, ASA physical status 1 or 2, infants were randomly assigned into two groups: high-flow anesthesia (HFA) or low-flow anesthesia (LFA). An identical semi-closed Dr ger circle anesthesia system (Cato) was used to all patients. Initial fresh gas flow (FGF) was N2O 1.5 L/min and O2 1.5 L/min in both groups. This FGF of 3 L/min was maintained in the HFA group. After 10 min of HFA, the FGF was reduced to 500 ml/min (N2O 250 ml/min and O2 250 ml/min) in the LFA group. RESULTS: Hypoxic or hypercarbic gas concentrations were not observed in all patients. Enflurane consumption during LFA was about 1/3 of that during HFA (6.8 +/- 1.3 ml vs. 19.5 +/- 5.8 ml). The mean highest esophageal temperature was similar in both groups. The mean highest inspiratory gas and soda lime temperatures were significantly higher in the LFA group than in the HFA group. CONCLUSIONS: Low-flow anesthesia in a circle system with a fresh gas flow of N2O 250 ml/min and O2 250 ml/min could be performed safely and economically for infants.

Low Flow Anesthesia with Continuous Infusion of Liquid Enflurane into Breathing Circuit / 대한마취과학회지

BACKGROUND: Lowe and Ernst's square root of time model employs direct injection of liquid agent into breathing circuit for low flow anesthesia. Intermittent injections of the agent by Lowe's method change rapidly arterial partial pressure of the agent and fail to maintain hemodynamic stability to surgical stimuli. We designed to investigate the possibility and safety of low flow anesthesia with continuous infusion of liquid enflurane into breathing circuit. METHODS: Twenty patients, ASA physical status I or II, undergoing gastrectomy under inhalational general anesthesia were randomly divided into two groups. Anesthesia was maintained with a fresh gas flow of O2 500 ml/min and continuous infusion of liquid enflurane. An identical semiclosed Dr ger circle anesthesia system was used to all patients. Liquid enflurane calculated by the Lowe's method (group I) or simplified by patient's weight (group II) was continuously infused directly into inspiratory limb of breathing circuit using syringe pump. Inspiratory and expiratory concentrations of enflurane, enflurane consumptions, hemodynamic parameters, carboxyheomoglobin were checked intraoperatively. Hepatic and renal functions were evaluted postoperatively. RESULTS: Liquid enfurane was initially infused at a rate in ml/hr of 16.1 0.8 weight in kg in group I and 1.0 weight in kg in group II. After 5 minutes the infusion rate was reduced to 20% of this value and then well adjusted to maintain blood pressure within 20% of the reference preoperative value. Enflurane consumptions and recovery time were similar between the two groups. There were no clinical significant changes in arterial blood gas, carboxyheomoglobin, and hepatic and renal functions. CONCLUSIONS: These data show that low flow anesthesia with continuous infusion of liquid enflurane into breathing circuit is safe and effective, and that the infusion method simplified by patient's weight may easily be applied to clinical practice for low flow anesthesia.