ABSTRACT
Since lithotripsy of renal calculi by shock waves is painful, it requires anesthesia. General or regional anesthesia technics may be used. Of more than 1000 treatments at the University Hospital of Zurich, over 90% were done under epidural anesthesia. It is necessary to extend the anesthesia up to the level of Th 4/5 to block all painful sensations. 1-2% carbonated lidocaine was found to be the most suitable anesthetic, providing fast onset and reasonable duration of anesthesia and thus allowing early mobilisation of the patient after treatment. Approximately 3% of the patients were primarily scheduled for general anesthesia for several reasons. These patients were intubated and ventilated by a conventional anesthesia machine at 40-60 breaths per minute. With the small tidal volumes of 200-300 ml there was only minimal displacement of the concretions by respiratory movements. Monitoring of the endtidal CO2 turned out to be problematic in some cases. Epidural anesthesia with carbonated lidocaine is a highly suitable method for anesthesia in over 90% of lithotripsy treatments.
Subject(s)
Anesthesia, Epidural , Kidney Calculi/therapy , Lidocaine , Lithotripsy , Anesthesia, General , HumansABSTRACT
The indices of P a-A CO2, P A-a O2 and VD/VT were evaluated in a group of children treated with controlled ventilation (IPPV) for: pneumonia, congenital heart disease, respiratory distress syndrome or central nervous system diseases. The P A-a O2 index is regarded as the most useful one, since it enables the possibility to select a F IO2 value for obtaining an optimal P aO2. For calculation of VD/VT according to Bohr's formula during connection of the child to respirator P ECO2 was determined planimetrically from the capnographic curve. P a-A CO2 was recognized as a less useful index and difficult to interpret.
Subject(s)
Carbon Dioxide/blood , Intermittent Positive-Pressure Breathing , Lung Volume Measurements , Oxygen/blood , Positive-Pressure Respiration , Respiratory Dead Space , Tidal Volume , Adolescent , Carbon Dioxide/metabolism , Central Nervous System Diseases/complications , Child , Child, Preschool , Heart Defects, Congenital/complications , Humans , Infant , Infant, Newborn , Oxygen Consumption , Pneumonia/complications , Pulmonary Alveoli/metabolism , Respiratory Distress Syndrome, Newborn/complications , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapyABSTRACT
A transient rise of intracranial pressure in cats under chloralose-urethane anaesthesia increased the activity of the sympathetic vertebral nerve, cardiac nerve and in the first phase phrenic nerve. If the vagus nerves were intact this rise in sympathetic activity was associated with bradycardia. These effects developed with a delay, as a rule after abatement of the transient intracranial pressure rise. The authors suggest that Cushing's reaction is caused by medullary ischaemia and development of local metabolic acidosis activating simultaneously the sympathetic and parasympathetic neurons in the medulla oblongata.
