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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Absence of cough and gag reflexes has been noted in premature infants, but pulmonary irritant reflexes have not been studied. Irritant receptors respond to deflation, direct stimulation, or inhalation of irritant gases, resulting in an increased inspiratory effort. We have studied the responses of 28 intubated infants to direct bronchial mucosal stimulation with a fine catheter. Six of ten infants whose gestation was 35 weeks or more consistently showed a "mature" response, with an increase in inspiratory effort, while only one of 18 infants less than 35 weeks consistently showed this response. The premature infants showed variable responses. Fifty-eight of 93 stimulations produced an increased inspiratory effort, followed by marked slowing or apnea, while 20 stimulations resulted in slowing or apnea alone. These paradoxical responses to irritant stimulation may be related to immaturity of vagal myelination, and may be an important factor in the frequency of silent aspiration and apnea in premature infants.
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PMID:Functional immaturity of pulmonary irritant receptors and apnea in newborn preterm infants. 66 75

As a result of the authors' experience they advocate posterior fossa decompression in patients with myelomeningocele at the first sign of compression of bratn stem or the cervical cord or both. If decompression is not undertaken at once the impaired gag and cough reflexes place the child at risk. He may develop pneumonia. If decompression is delayed too long full neurological recovery will not occur. The removal of bone and the opening of dura must be carried down to the bottom of the tonsillar tip, sometimes as low as C7. The most dramatic improvement occurs in infants whose symptoms are life threatening. Less dramatic but just as real is the improvement in older children. Although investigations such as myelography and ventriculography will show the malformation, they are not essential. The associated visible malformations and the clinical condition are the most reliable means of making the diagnosis. Delaying the decompression risks the life of the infant and threatens the quality of life for the older child.
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PMID:Manifestations and management of Arnold-Chiari malformation in patients with myelomeningocele. 110 68

A 68 year old male with multisystemic disease, mainly lungs and heart, was treated with a cuffed endotracheal tube, mechanical ventilation and a 16 Fr Levin nasogastric tube for feeding; it was substituted 13 days later by a 2.3 mm, 8 Fr O'Brien KMI polyurethane small bore enteral feeding tube introduced with a guide wire. The feeding tube perforated his right lung and passed into the pleural cavity, either through the larynx or through a nonconfirmed tracheoesophageal fistula; signs for the supposedly correct position of the tube were positive. In patients with depressed sensoria, abnormalities of gag or cough reflexes, esophageal strictures, significant cardiomegaly or tracheoesophageal fistula, small bore enteral feeding tubes should be passed under direct vision by laryngoscopy or preferably by flexible endoscopy; adequate confirmation of the correct position requires a chest and an upper abdominal roentgenogram.
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PMID:[Lung perforation by a small-bore enteral feeding tube]. 143 15

Conventional aerosol techniques were used to determine if inhalation of lidocaine can supplement topical anesthesia applied during bronchoscopy. Aerosols of either saline or lidocaine (50 mg at either 2 or 4% concentrations) were generated by jet nebulizer and administered with or without intermittent positive-pressure breathing. Patients (n = 38) after aerosol inhalation were administered 2% lidocaine (atomized and instilled) for suppression of the gag reflex, control of cough, and airway anesthesia. For five of the patients, prior to bronchoscopy, additional studies with radioaerosols and scintillation scans were accomplished with the same aerosol methodology to demonstrate lung distribution of deposited aerosol. For five patients who received 2% lidocaine aerosol prior to bronchoscopy, the subsequent topical dose of anesthetic required for the procedure was 186 +/- 34 (SEM) mg lidocaine. Nine patients in a control group received saline aerosol and required significantly more anesthetic, i.e., 308 +/- 26 mg; procedures were completed on average within 50 min. The largest difference was in the amount delivered to the upper airway (naris, pharynx, epiglottis, and larynx), i.e., 144 +/- 26 mg for saline control versus 48 +/- 16 mg for lidocaine aerosol protocol. Airways distal to the cords required less anesthesia also, on average, 77 mg for the saline control versus 46 mg for the lidocaine aerosol protocol (p < 0.05). Topical anesthetic dosage data were replicated in 12 additional patients studied by a different bronchoscopist. No additional benefit was afforded by premedication with 4% lidocaine aerosol rather than the 2% aerosol (n = 12). We conclude that aerosol modalities can supplement topical anesthesia during bronchoscopy, primarily by reducing the dose required to anesthetize the upper airway.
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PMID:Aerosolized lidocaine reduces dose of topical anesthetic for bronchoscopy. 148 50

The aim of this work was to compare the efficacy of the Cetacaine topical anesthetic spray preparation to placebo. Cetacaine and placebo, from coded but otherwise identically packaged and scented sprays, were administered to 150 consecutive patients. After endoscopy, patients and physicians completed questionnaires evaluating the difficulty of the endoscopy. No statistically significant differences were found between the full formula and placebo-treated patient responses to the amount of cough or gag, or the degree of difficulty of intubation of the endoscope. Analysis of physician responses showed that in the subgroup of patients being endoscoped for the first time, the gastroscope was introduced more easily (p less than 0.05) when the premedication had been full formula rather than placebo.
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PMID:Topical pharyngeal anesthesia for easing endoscopy: a double-blind, randomized, placebo-controlled study. 217 38

Seventy patients with bilateral strokes underwent neurologic and videofluoroscopic barium swallowing examinations; 34 (48.6%) aspirated. Patients with aspiration were more likely to have posterior circulation strokes, abnormal cough, abnormal gag, and dysphonia. However, patients likely to aspirate can be identified best by the presence of an abnormal voluntary cough, an abnormal gag reflex, or both. The prediction of patients at risk for aspiration was not improved by additional clinical information (ie, presence of dysphonia or bilateral neurologic signs).
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PMID:Aspiration in bilateral stroke patients. 223 22

Seventeen adult patients in whom small-diameter, flexible-tipped feeding tubes had been inadvertently placed in the lung were identified during a 22-month period. In nine patients pneumothorax developed, all cases due to transpleural passage of small-diameter (2.7-mm) feeding tubes. In one of these patients, hydropneumothorax and subsequent empyema developed. Placement of larger diameter (4.3-mm) feeding tubes did not lead to pneumothorax, but pneumonitis developed in one patient after intrapulmonary instillation of antacid solution. Of the 17 patients, 15 had impaired mental status or diminished gag, cough, or swallowing reflexes; the remaining two were pharmacologically sedated during the procedure. Radiographic confirmation of feeding tube placement is essential to avoid these complications, with particular attention paid to the course of the tube.
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PMID:Inadvertent tracheobronchial placement of feeding tubes. 312 Feb 38

In order to deprive vagal upper and large airway receptors, an aerosol of 4% lidocaine (240 mg) was delivered to eight normal subjects and to eight eucapnic patients with chronic obstructive pulmonary disease (COPD). After this procedure, gag reflex (mechanical irritation of the larynx) and cough reflex tested by an aerosol of 10% citric acid were absent in all subjects. The anaesthesia was tolerated well by all the subjects and did not influence baseline pulmonary function tests. Moreover, during exercise, before and after lidocaine, no significant difference in O2 intake (VO2) or in blood gases (measured in patients only) could be observed. After lidocaine administration, no significant changes were seen in any of the respiratory variables studied in normal subjects or in COPD patients compared to the basal conditions. This could indicate that vagal upper and large airway receptors do not play an important role for the breathing pattern and ventilatory drive during exercise either in normal subjects or eucapnic patients with COPD.
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PMID:Airway anaesthesia and breathing pattern during exercise in normal subjects and in eucapnic patients with chronic airflow obstruction. 376 71

The pediatric Cantor tube is a simple and safe method to provide enteral nutrition in patients requiring ventilatory support. The tube does not become dislodged when patients gag or cough while undergoing suctioning.
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PMID:A simple technique for enteral feedings in patients on ventilators. 391 6

To evaluate the contribution of vagal airway receptors to ventilatory control during hypercapnia, we studied 11 normal humans. Airway receptor block was induced by inhaling an aerosol of lidocaine; a preferential upper oropharyngeal block was also induced in a subgroup by gargling a solution of the anesthetic. Inhalation of lidocaine aerosol adequate to increase cough threshold, as measured by citric acid, did not change the ventilatory response to CO2, ratio of the change in minute ventilation to change in alveolar PCO2 (delta VI/delta PACO2), compared with saline control. Breathing pattern at mean CO2-stimulated ventilation of 25 l/min showed significantly decreased respiratory frequency, increased tidal volume, and prolonged inspiratory time compared with saline. Resting breathing pattern also showed significantly increased tidal volume and inspiratory time. In nine of the same subjects gargling a lidocaine solution adequate to extinguish gag response without altering cough threshold did not change delta VI/delta PACO2 or ventilatory pattern during CO2-stimulated or resting ventilation compared with saline. These results suggest that lower but not upper oropharyngeal vagal airway receptors modulate breathing pattern during hypercapnic as well as resting ventilation but do not affect delta VI/delta PACO2.
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PMID:Effects of upper or lower airway anesthesia on hypercapnic ventilation in humans. 405 88


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