Subject(s)
Laryngeal Masks , Tracheal Diseases/therapy , Bronchial Diseases/therapy , Carbon Dioxide/blood , Equipment Design , Humans , Infant , Infant, Newborn , Infant, Premature , Male , Oxygen/bloodABSTRACT
A 67-year-old male was scheduled for cadaveric renal transplant. Following rapid sequence anaesthesia, only the tip of the epiglottis was visualized. Mask ventilation was difficult, and therefore an alternative airway device was considered. A size 4 CobraPLA (Engineered Medical System, Indianapolis, IN) was inserted into the hypopharynx, and ventilation was easily accomplished. Then, a size 7 endotracheal tube was threaded over a fiberoptic bronchoscope, through the CobraPLA, into the trachea. The description and insertion technique of the CobraPLA, a new supraglottic airway device is shortly discussed. This is the first report of successful management of difficult mask ventilation with the new CobraPLA, supraglottic airway device.
Subject(s)
Airway Obstruction/therapy , Intubation, Intratracheal/instrumentation , Laryngeal Masks , Aged , Airway Obstruction/etiology , Bronchoscopy/methods , Equipment Design/methods , Fiber Optic Technology/instrumentation , Humans , Intubation, Intratracheal/methods , MaleSubject(s)
Intubation, Intratracheal/methods , Spine/abnormalities , Spondylitis, Ankylosing/complications , Adult , Humans , MaleSubject(s)
Intubation, Intratracheal/methods , Female , Humans , Intubation, Intratracheal/instrumentation , Male , SafetySubject(s)
Lung , Pulmonary Alveolar Proteinosis/therapy , Drowning/prevention & control , Humans , Intubation, Intratracheal/methods , Lung/diagnostic imaging , Lung/physiology , Pulmonary Alveolar Proteinosis/diagnostic imaging , Pulmonary Alveolar Proteinosis/physiopathology , Pulmonary Gas Exchange , Radiography , Therapeutic Irrigation/methodsABSTRACT
The authors attempted to favorably manipulate the distribution of pulmonary blood flow during unilateral atelectasis and during unilateral lung lavage by nonocclusive inflation of an ipsilateral pulmonary artery catheter balloon (PAB). Six mongrel dogs were anesthetized, intubated with a double-lumen endotracheal tube, and following a thoracotomy, pulmonary artery and left lung blood flows (Qt and QLL/Qt, respectively) were measured electromagnetically; right lung blood flows (QRL/Qt) were derived by difference. A PAB was positioned in the right main pulmonary artery. The experimental sequence consisted of seven steps: 1) both lungs ventilated; 2) ventilation of the left lung (LL vent), right lung (RL) atelectatic, PAB deflated; 3) LL vent, RL atelectatic, PAB inflated; 4) LL vent, RL lavaged, PAB deflated; 5) LL vent, RL lavaged, PAB inflated; 6) LL vent, RL drained, PAB deflated; and 7) LL vent, RL drained, PAB inflated. At each step the shunt fraction (Qs/Qt) was determined. Inflation of the PAB during LL vent and RL atelectatic (step 3) caused QRL/Qt and Qs/Qt to decrease and QLL/Qt and PaO2 to increase significantly (compared to step 2). There were no significant differences in QRL/Qt, QLL/Qt, Qs/Qt, and PaO2 during RL lavage with the PAB deflated (step 4) compared to RL lavage with the PAB inflated (step 5). Inflation of the PAB during RL drainage (step 7) caused QRL/Qt to decreased and QLL/Qt to increase significantly compared to their values during periods of RL drainage with the PAB deflated (step 6). This resulted in a significant increase in PaO2 and decrease in Qs/Qt. These results demonstrate that the distribution of pulmonary blood flow in dogs can be favorably manipulated by nonocclusive ipsilateral PAB inflation and support a trial of use in selected patients during one-lung anesthesia and ventilation.
Subject(s)
Lung/physiology , Pulmonary Artery/physiology , Animals , Arteries , Assisted Circulation , Dogs , Drainage , Oxygen , Partial Pressure , Pulmonary Atelectasis/physiopathology , Regional Blood Flow , Respiration , Therapeutic IrrigationABSTRACT
A new CPAP device is described which is simple, lightweight, easily constructed, and not functionally dependent on gravity or valves. The device consists of a conventional T-piece into which a small nozzle is placed opposite, but projecting towards, the patient connection. When a flow of oxygen is delivered through the nozzle, continuous positive pressure within the airway results. The device was evaluated with a mechanical lung model, in human volunteers using various breathing patterns and in intubated patients requiring transport within the hospital. In all three situations, the device provided 7-15 torr end-expiratory pressure and an FIO2 of 0.40-0.90 using oxygen flow rates of 10-30 L/min. The device is safe, reliable, and can be easily adapted to provide IMV when required. Clinical applications are discussed.
Subject(s)
Positive-Pressure Respiration/instrumentation , Evaluation Studies as Topic , HumansABSTRACT
The deliberate reduction of blood pressure in an attempt to reduce intraoperative blood loss has generated significant controversy in the 30 years since its clinical introduction. Numerous series have been reported, but few have met generally accepted, current criteria for controlled studies. In this article, the effect of blood pressure reduction on organ perfusion will be presented together with a review of techniques of achieving hypotension. A summary of results is included and, based on this data, recommendations are offered regarding the application and limits of deliberate hypotension.
