ABSTRACT
Thoracoscopy has become a widely used method of achieving minimally invasive thoracic surgery. The anesthesiologist providing perioperative care for VATS is challenged to evaluate the patient carefully; to design a safe anesthetic regimen, taking into account preexisting disorders; to ameliorate physiologic alterations associated with one-lung ventilation and CO2 insufflation; and to provide safe, effective perioperative anesthesia and postoperative pain control.
Subject(s)
Anesthesia/methods , Thoracoscopy , Humans , Intubation, Intratracheal , Lung/physiopathology , Monitoring, Physiologic , Pain, Postoperative/drug therapy , Physical Examination , PostureABSTRACT
The fact that collateral ventilation normally occurs in the human lung has led to the suggestion that it might contribute to the successful clinical effects of low-compression high-frequency positive-pressure ventilation (HFPPV). As the pig has poor collateral ventilation, pulmonary vasoconstriction has to be part of the regulatory mechanisms matching ventilation-perfusion. A study was made on nine pigs anesthetized with ketamine hydrochloride intravenously to elucidate the maintenance of ventilation-perfusion balance during mechanical ventilation. Comparisons were made between the ventilatory patterns provided by a conventional ventilator (Servo-Ventilator 900C) and an improved prototype of a low-compression system for volume-controlled ventilation (system H). A ventilatory frequency of 20 breaths per min (bpm) with SV-900C (SV-20) and system H (H-20) and of 60 bpm with system H (H-60) was used. The experimental conditions were otherwise identical. Positive end-expiratory pressures (PEEP) were applied to maintain the same mean airway pressure with the three systems. The tidal volume required for normoventilation differed significantly between the three ventilatory patterns, but there were no differences in circulatory and oxygen-transport variables. By measurements of airway pressure and intrapleural liquid surface pressure, it was demonstrated that the distending pressure (at end-inspiration) was significantly lower with a low-compression system (H-20 versus SV-20), especially at a high ventilatory frequency (H-60 versus H-20). Consequently, although the mean airway pressure was set at the same level for the three different ventilatory modalities, the distending pressures required for the same alveolar ventilation and arterial oxygenation differed significantly.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Positive-Pressure Respiration/methods , Pulmonary Gas Exchange , Animals , Pressure , Respiration , Swine , Tidal Volume , Time FactorsSubject(s)
Arachis , Bronchi , Bronchoscopy , Epinephrine/administration & dosage , Foreign Bodies/therapy , Racepinephrine , Aerosols , Bronchi/blood supply , Bronchi/drug effects , Child, Preschool , Female , Humans , Infant , Inhalation , Male , Mucous Membrane/blood supply , Mucous Membrane/drug effects , Vasoconstriction/drug effectsABSTRACT
Water entrainment into opened prostate venous sinuses during transurethral resection of the prostate (TURP) may lead to dilution of serum electrolytes. Dilutional hypokalemia may precipitate digitalis toxicity in the digitalized patient. Successful resuscitation of such a patient is reported.
Subject(s)
Digitalis Glycosides/toxicity , Hypokalemia/complications , Prostatectomy/adverse effects , Arrhythmias, Cardiac/chemically induced , Arrhythmias, Cardiac/drug therapy , Humans , Hypokalemia/drug therapy , Hypokalemia/etiology , Infusions, Parenteral , Lidocaine/administration & dosage , Magnesium Sulfate/administration & dosage , Male , Middle Aged , Potassium Chloride/administration & dosage , Prostatectomy/methodsABSTRACT
Pheochromocytoma which is diagnosed intraoperatively carries a high morbidity and mortality. Successful management of the patient with unsuspected pheochromocytoma requires a high index of suspicion and aggressive pharmacologic intervention.
