RESUMO
We have observed transient diaphragmatic paralysis with high alveolar to arterial oxygen partial pressure difference following radical neck surgery. Patients required supplemental oxygen for maintenance of arterial oxygenation. Patients following radical and neck surgery should be followed with chest roentgenograph to exclude pneumothorax and diaphragmatic paralysis and arterial blood gases in the immediate postoperative period.
Assuntos
Esvaziamento Cervical/efeitos adversos , Paralisia Respiratória/etiologia , Idoso , Diafragma/inervação , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Oxigenoterapia , Nervo Frênico/lesões , Complicações Pós-Operatórias/terapia , Paralisia Respiratória/terapiaAssuntos
Dispneia/etiologia , Ventiladores Mecânicos , Idoso , Falha de Equipamento , Humanos , MasculinoRESUMO
The possibility of enflurane-induced spike activity being related to a cholinergic mechanism was investigated. Thirty mongrel dogs were anesthetized with an inspired enflurane concentration of 3.5 +/- 0.09% (mean +/- SD) to obtain a sustained EEG spike activity. Scopolamine, in 0.04 mg/kg to 0.4 mg/kg IV doses, significantly decreased the spike activity (p less than 0.05). We speculate that a central cholinergic muscarinic mechanism is at least partly responsible for the EEG spike activity produced by enflurane.
Assuntos
Potenciais de Ação/efeitos dos fármacos , Encéfalo/fisiologia , Enflurano , Escopolamina/farmacologia , Animais , Encéfalo/efeitos dos fármacos , Cães , EletroencefalografiaRESUMO
Contaminated respiratory therapy equipment may be responsible for the spread of pathogens to hospital patients. This study focused on the potential for contamination of prefilled, sterile, disposable water and saline systems for humidification and nebulization. Gas and liquid samples from 48 prepacked oxygen humidifier/cannula and 26 prepacked nebulization setups were taken at the initial application of devices and at 8, 24, 48, and 72 hour intervals, totaling 386 cultures. All samples from the humidifier units were found to be pathogen-free for up to 3 days. A total of six or 3.84% of the nebulizer samples showed contamination with Enterobacter cloacae after 8 to 24 hours of operation. It was concluded that the potential for contamination of the humidifiers is low for up to 72 hours, but the nebulizer units should be changed after 24 hours even though their contamination rate is markedly lower than that of conventional nondisposable units.
Assuntos
Antissepsia , Assepsia , Infecção Hospitalar/transmissão , Umidade , Oxigenoterapia/instrumentação , Infecções Respiratórias/microbiologia , Hospitais de Veteranos , Humanos , Indiana , Unidades de Terapia IntensivaRESUMO
Left atrial catheters are used to measure left heart filling pressure in patients after open-heart surgery. It was observed that in some patients blood gases obtained from the left atrial catheters had a markedly higher PO2 as compared to PaO2 in the presence of severe hypoxemia. Twenty-five patients were studied consecutively; pulmonary venous admixture calculated from arterial blood was higher in 19 patients and lower in 5 as compared with that calculated from blood withdrawn from the left atrial catheter. These differences in venous admixture are due to regional changes in the lungs. This observation can be utilized in concentrating respiratory therapy to the regions of the lungs involved with significant therapeutic benefit to the patient.
Assuntos
Gasometria , Cateterismo Cardíaco , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Critically ill hypoxemic patients without significant radiological changes on the chest x-ray present a diagnostic and therapeutic problem. Three patients with patent foramen ovale and a patient with a spontaneously closed congenital ventricular septal defect which reopened due to ischemic changes in the ventricular septum are presented. In reviewing the literature, we could not find this type of presentation. Their hypoxemia was associated with right-to-left intracardiac shunts demonstrated by dye dilution cardiac output curves. Because of the risk of systemic embolism associated with a right-to-left intracardiac shunt, air bubbles and particulate material in the intravenous infusion should be avoided. Use of anticoagulants may be beneficial. High inspired oxygen concentration may not correct the associated hypoxemia. The detection of these shunts is easily done at the bedside.
Assuntos
Fístula/complicações , Hipóxia/etiologia , Adulto , Idoso , Fístula/diagnóstico por imagem , Cardiopatias/complicações , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Ventrículos do Coração , Humanos , Masculino , RadiografiaRESUMO
A patient with documented hereditary angioneurotic edema was admitted for elective surgical extraction of 3 impacted 3rd molars under local anesthesia. In order to increase his C'1-INH level, he was prepared for operation with 2 units of fresh-frozen plasma 24 hours preoperatively. Postoperatively, he was observed in the ICU for 24 hours and on the ward for 2 days, and was discharged without any complications from the surgical trauma.
Assuntos
Anestesia Local , Angioedema/complicações , Extração Dentária , Dente Impactado/complicações , Adulto , Angioedema/genética , Humanos , Masculino , Cuidados Pré-Operatórios , Dente Impactado/cirurgiaRESUMO
A 7-year-old girl manifested the rare anomaly of a ventricular septal defect (VSD) with left aortic arch, right descending aorta, and right ligamentum arteriosum. After open-heart surgery to correct the VSD, symptoms of tracheal obstruction on spontaneous breathing developed, due to tracheal compression by the right ligamentum arteriosum. The compressed segment of the trachea was found to be thin and unstable following division of the ligamentum. Positive-pressure breathing and continuous positive airway pressure breathing effectively splinted the patient's airway during the postoperative period, with recovery of the patient.
