ABSTRACT
The authors report a case of sudden desaturation upon creating pneumoperitoneum during laparoscopic cholecystectomy, which was most probably caused by endobronchial intubation. The literature of the previously reported cases is reviewed. Differential diagnosis and different mechanisms are discussed. Recommendations are suggested to avoid this problem.
Subject(s)
Cholecystectomy, Laparoscopic/adverse effects , Hypoxia/etiology , Pneumoperitoneum, Artificial/adverse effects , Adult , Female , HumansABSTRACT
The output of 30 Tec 3 vaporizers (halothane, enflurane and isoflurane) was studied, starting at the point where no liquid was visible in the content window. At 6 l.min-1 and 1% v/v initial output, consistent delivery was on average maintained for in excess of 90 (range 55-120) min. Thereafter, output declined rapidly. At the flows and concentrations studied there is a significant reserve in the vaporizing chamber, but it is likely that when higher flows and concentrations are used this reserve may be substantially reduced.
Subject(s)
Anesthesia, Inhalation/instrumentation , Nebulizers and Vaporizers , Enflurane/administration & dosage , Equipment Design , Halothane/administration & dosage , Humans , Isoflurane/administration & dosage , Time FactorsSubject(s)
Bronchoscopes , Laryngoscopy/methods , Teaching , Equipment Design , Humans , LaryngoscopesABSTRACT
We modified a Penlon Nuffield 200 for use in a monoplace hyperbaric oxygen chamber by feeding back the chamber pressure to the reducing valve of the Nuffield 200. This provides a compensating mechanism, allowing the ventilator to deliver adequate tidal volumes at pressures of up to 3 atmospheres. We report the laboratory testing of the ventilator and our experience of ventilating two patients with carbon monoxide poisoning. Although compensation is not complete the modification is adequate for short-term clinical use in patients in whom the airway is compromised but who need hyperbaric oxygen therapy.
