RESUMEN
Several modifications of the Bain system for nitrous oxide analgesia or general anesthesia were tested for rebreathing and retention of CO2. The classic Bain circuit causes the most rebreathing as measured by the fractional concentration of CO2 in a sample of inspired gas (FICO2), but stimulation of the respiratory system seems to allow near normal end tidal CO2 and arterial CO2 tensions. The most predictable systems that have the least amount of rebreathing are those that have the least dead space.
Asunto(s)
Anestesia Dental/métodos , Anestesia por Inhalación/métodos , Dióxido de Carbono/metabolismo , Óxido Nitroso , Respiración , Anestesia Dental/instrumentación , Anestesia por Inhalación/instrumentación , Dióxido de Carbono/sangre , Diseño de Equipo , Humanos , Oxígeno , Volumen de Ventilación PulmonarRESUMEN
Despite various technical manipulations through contemporary endoscopic equipment, large tracheal foreign bodies may be lost during bronchoscopic extraction, with a 1 to 2% in-hospital mortality. Recently, emergency tracheostomy was performed during bronchoscopy after a tracheal foreign body had become dislodged in the subglottic region causing blockage of the airway, and the results of this procedure provoked its deliberate application in a second patient. In 3 additional infants, aspirated tracheal T tubes (Montgomery tubes), which were producing acute respiratory distress, were brought from the carina to the performed tracheostoma under bronchoscopic manipulation and were withdrawn. Elective application of this simultaneous approach--tracheostomy with bronchoscopy--may decrease morbidity and mortality from large tracheal foreign bodies.
Asunto(s)
Broncoscopía , Cuerpos Extraños/cirugía , Tráquea , Traqueotomía , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/cirugía , Cuerpos Extraños/complicaciones , Humanos , Lactante , MasculinoAsunto(s)
Procedimientos Quirúrgicos Cardíacos , Monitoreo Fisiológico/instrumentación , Oxígeno/sangre , Presión Sanguínea , Gasto Cardíaco , Cateterismo/instrumentación , Niño , Humanos , Lactante , Unidades de Cuidados Intensivos , Masculino , Monitoreo Fisiológico/métodos , Cuidados PosoperatoriosAsunto(s)
Espasmo Bronquial/etiología , Puente Cardiopulmonar/efectos adversos , Aminofilina/uso terapéutico , Espasmo Bronquial/tratamiento farmacológico , Puente de Arteria Coronaria , Epinefrina/uso terapéutico , Femenino , Humanos , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana EdadRESUMEN
Carbon dioxide retention in the Storz rigid ventilating bronchoscope with the Hopkins lens system was investigated in the laboratory. The 3.5, 4.0, and 5.0 30-cm Storz bronchoscopes with a 3.95-mm (outside diameter) telescope lens were used in 10 mongrel dogs weighing between 8 and 15 kg. Significant (p less than 0.01) accumulation of arterial carbon dioxide tension (PaCO2) (respiratory acidosis) was observed after 5 and 10 minutes of ventilation through the 3.5 and 4.0 bronchoscopes, but no significant increase in PaCO2 was noted with the 5.0 bronchoscope. There was no significant change in arterial oxygen tension under the same conditions. Manual compression of the upper anterior abdominal wall during expiration was applied during bronchoscopy in 6 children. Arterial blood samples were taken before insertion of the bronchoscope and 5 minutes later with and without abdominal compression during expiration. A significant increase (p less than 0.05) in PaCO2 and a decrease in pH were observed after 5 minutes of the bronchoscopic procedure without manual compression of the abdominal wall, while no significant changes in PaCO2 were observed with abdominal compression.