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

The effect of iv methohexital infusion anesthesia on functional residual capacity (FRC) (helium dilution) in 14 surgical patients (age 23 to 59 years) was determined. Eight subjects were studied wearing an inflatable mask, sealed with surgical lubricant. They showed a mean +/- SD 3.5 +/- 6.4% FRC decrease (no significance). Six subjects studied via mouthpiece awake and via endotracheal tube during anesthesia showed a mean 22 +/- 19% reduction in FRC, significantly greater than face mask studies (P less than 0.05). The greatest FRC decrease occurred in subjects with repetitive or protracted coughing after intubation. The serum methohexital level was 6.6 +/- 3.6 micrograms/ml for intubated patients, and 6.0 +/- 1.1 micrograms/ml in those with face mask (no significance). The depth of anesthesia was sufficient to produce a 50% reduction in ventilatory response to CO2 rebreathing, from 15.8 to 8.7 l/min/% CO2. Respitrace plethysmography indicated a 38 +/- 12% ribcage contribution to tidal volume during quiet breathing, which increased to 47 +/- 14% with CO2 breathing (end-tidal FCO2 9-10%). There was no dimunition of ribcage contribution during anesthesia in either group, irrespective of CO2 concentration. The authors interpret their findings to indicate that iv methohexital anesthesia does not produce FRC reduction, in contrast to an inhaled anesthetic such as halothane. It is proposed that this difference may be related to maintenance of coordinated ribcage/diaphragm muscle activity, because ribcage activity is markedly suppressed by halothane. In addition, it is proposed that FRC reduction in intubated subjects was the result of a confounding variable, namely coughing in response to the endotracheal tube.
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PMID:Effects of barbiturate anesthesia on functional residual capacity and ribcage/diaphragm contributions to ventilation. 381 77

The effect on ventilation of airway anaesthesia, produced by the inhalation of a 5% bupivacaine aerosol (aerodynamic mass median diameter = 4.77 micron), was studied in 12 normal subjects. The dose and distribution of the aerosol were determined from lung scans after the addition to bupivacaine of 99mTc. Bupivacaine labelled in this way was deposited primarily in the central airways. The effectiveness and duration of airway anaesthesia were assessed by the absence of the cough reflex to the inhalation of three breaths of a 5% citric acid aerosol. Airway anaesthesia always lasted more than 20 min. Resting ventilation was measured, by respiratory inductance plethysmography, before and after inhalation of saline and bupivacaine aerosols. The ventilatory response to maximal incremental exercise and, separately, to CO2 inhalation was studied after the inhalation of saline and bupivacaine aerosols. Breathlessness was quantified by using a visual analogue scale (VAS) during a study and by questioning on its completion. At rest, airway anaesthesia had no effect on mean tidal volume (VT), inspiratory time (Ti), expiratory time (Te) or end-tidal PCO2, although the variability of tidal volume was increased. On exercise, slower deeper breathing was produced and breathlessness was reduced. The ventilatory response to CO2 was increased. The results suggest that stretch receptors in the airways modulate the pattern of breathing in normal man when ventilation is stimulated by exercise; their activation may also be involved in the genesis of the associated breathlessness. A hypothesis in terms of a differential airway/alveolar receptor block, is proposed to explain the exaggerated ventilatory response to CO2.
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PMID:The effect of airway anaesthesia on the control of breathing and the sensation of breathlessness in man. 391 83

We investigated the influence of Forced Diffusion Ventilation (FDV), a special form of High Frequency Ventilation (HFV), on elevated intracranial pressure (ICP) in 5 dogs. Elevation of ICP was standardized by inflation of an epidural balloon. A typical finding with FDV is a reduced intrapleural pressure and therefore one could expect a better cerebrovenous drainage influencing ICP. Nevertheless, we found no changes in mean ICP under conditions of FDV compared with IPPV. Respirator-synchronous fluctuations of ICP, cisternal cerebrospinal fluid pressure and intrapleural pressure were drastically reduced with FDV. This phenomenon has been already reported by other groups as a typical effect of HFV with rates of 100/min. One can speculate, that this immediate impact of HFV on ICP-curves might be of some advantage in patients with critically reduced intracranial compliance requiring long-term artificial ventilation, because peaks and amplitudes of ICP are reduced. Our clinical experience with High Frequency Pulsation (HFP) includes 11 patients with severe brain trauma. In clinical routine this method of HFV is more facile to applicate than FDV, because there is no need of a special endotracheal tube and sufficient CO2-elimination is not strongly dependent on precise position of the tube. But HFP, as FDV, includes all advantages of respiratory systems, that are open against atmosphere (coughing and simultaneous breathing, without drastically increasing airway pressure, suction during respiration, etc.). However, we could find no special advantages or disadvantages in ICP-course during long-term application of HFP (up to 10 days). Because application of HFV is dependent on special technical equipment, we investigated in 6 patients the influence of respiratory frequency, tidal volume and inspiratory flow on ICP-fluctuations using conventional ventilators. ICP was recorded by a new, self constructed pneumatic epidural pressure sensor. Ventilator-related ICP-fluctuations were found to be markedly reduced at frequencies of 20/min and usually eliminated at 30/min. We found an exponential correlation between ICP-fluctuations and respiratory frequency and there was no correlation between tidal volume and ICP. Central venous pressure amplitudes were found to be in linear correlation with respiratory frequency and tidal volumes as well. The amplitude of respiratory ICP-fluctuations seems to be more dependent on duration of expiratory time. As our findings demonstrate, artificial ventilation without entilator-related fluctuations in ICP ("brain-protective" ventilation) may be performed by conventional volume-constant, time-cycled ventilators.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Special artificial respiration procedures and intracranial pressure. Animal experiment studies, development and use of a new pressure measuring technic, clinical aspects]. 392 25

In chronically implanted rats, we examined the respiratory EMG activity of the two parts of the diaphragm, costal and crural, during sleep and wakefulness. Their activity was compared and contrasted with that of the EMG activity of the cricothyroid muscle. Whether in wakefulness, while grooming and drinking, or in nonrapid eye movement (non-REM) sleep, and independent of the gas mixture breathed (4 to 5% CO2 or 10% O2 in nitrogen), the two parts of the diaphragm paused during REM apnea episodes whereas the cricothyroid muscle ceased its activity or exhibited sustained activity. We conclude that the diaphragm, mainly an inspiratory muscle, acts as a single functional unit when under the respiratory control system. The cricothyroid muscle functions as an inspiratory and/or expiratory muscle, also under the respiratory control systems. Both muscles in the rat come under other neural control mechanisms governing nonrespiratory functions, e.g., swallowing, defecation, and coughing, but not vomiting.
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PMID:Unity of costal and crural diaphragmatic activity in respiration. 393 Feb 80

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

50 aspirotomy dilatation and evacuation (D and E) procedures in women whose durations of gestation varied from 14-18 menstrual weeks were followed by hysteroscopy in a test to determine whether the use of local anesthesia with uterotonic drugs could alleviate the problem of low intrauterine pressure caused by anesthesia-related uterine atony. Anesthesia was achieved by paracervical and intracervical block with lidocaine 1% with adrenaline 1:200,000, which provides a vasoconstrictive effect on the vessels of the lower uterine segment. Routine hysteroscopy was performed. The rate of flow of CO2 averaged 50-75 ml/min and never exceeded 75 ml/min. The average amount of CO2 used was 300 ml. Intrauterine pressure varied from 40-60 mmHg and the time required to complete the procedure ranged from 2-5 minutes. The major hysteroscopic observation was that the uterine cavity was almost always thoroughly evacuated. In 6 cases blood obscuring the hysteroscope lens seriously impaired visibility. 4 patients developed a cough shortly after the initiation of CO2 insufflation, probably due to CO2 microembolization. Although no incidence of serious morbidity or side effects occurred, further well documented studies are necessary to assess the safety of CO2 hysteroscopy after 2nd trimester abortion. It is however recommended that postabortion hysteroscopy be performed under local anesthesia to which adrenaline has been added.
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PMID:Carbon dioxide hysteroscopy immediately after second trimester abortion. 613 31

Tracheal or endobronchial metastases from distant primary malignancies are rare. Hemoptysis, dyspnea and cough are common nonspecific presenting symptoms. Renal, breast, thyroid and colon cancers are the most common malignancies associated with tracheobronchial metastases. Since 1979, five patients with tracheobronchial metastases from distant sites have been treated by the otolaryngology service at the Boston University Medical Center. Patients with advanced tumors previously treated by conventional modalities were referred for palliation of airway obstruction. Satisfactory palliation without significant morbidity was achieved in four out of five patients utilizing a CO2 surgical laser through a rigid bronchoscope system. Four patients died from advanced cancer, 1 to 18 months after laser surgery. Although tracheobronchial metastasis from extrathoracic malignancy is associated with a poor prognosis, palliation of airway obstruction can be achieved in most patients with endobronchial or tracheal tumor.
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PMID:Tracheobronchial obstruction from metastatic distant malignancies. 618 6

In 24 patients with cystic fibrosis (6-20 years old), divided into two groups, we studied indices of airways obstruction before, 20-30 min and 2 h after chest physiotherapy. The physiotherapy lasted for 30 min and included expectoration of 2-10 ml of sputum. In one group of 14 patients, studies were made only 30 min after chest physiotherapy. No significant improvements of the ventilatory tests occurred. In fact, Vmax at 25% of VC deteriorated (P less than 0.05) in this group as a whole. In some patients also CV/VC increased, and N2 and CO2 alveolar slopes became steeper. Only Gaw/TGV improved in 20% of the patients by more than 10% of the control value. In the second group of 10 patients, ventilatory studies were repeated 3 times at one month intervals. They did not change significantly at 20 min and 2 h after chest physiotherapy. Gaw/TGV value improved by more than 10% in 20% of the patients. During chest physiotherapy, the patients were stimulated to cough. This might contribute to the immediate negative effects on ventilatory function by causing collapse of the central airways, as documented by cinebronchographic studies in 8 patients.
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PMID:Chest physiotherapy and airway obstruction in patients with cystic fibrosis - a negative report. 688 55

A 9-year-old boy with respiratory disturbance associated with medullary lesions after pneumococcal meningitis is reported. Although he lives a normal daily life, he cannot cough or sneeze. A polysomnographic study revealed a low respiration rate and an irregular respiratory rhythm not only during REM sleep but also during slow wave sleep, and marked desaturation during sleep. Respiratory function tests including CO2 response revealed normal values. Magnetic resonance imaging demonstrated bilateral small lesions in the medulla. This patient is unusual because respiratory rhythm is impaired, without decreased ventilatory capacity or CO2 response, supporting the possibility that rhythmogenetic respiratory neurons are located in a limited area of the human medulla.
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PMID:Impairment of respiratory rhythmogenesis and sequelae of bacterial meningitis. 754 11

Airway maintenance with the laryngeal mask airway (LMA) was evaluated and compared to the endotracheal (ET) tube in 27 former premature infants and children with bronchopulmonary dysplasia (BPD) during second stage open-sky vitrectomy. The children were randomly assigned to a study group and anesthetized with halothane in N2O:O2. The airway was maintained with the LMA (n = 13) or the ET tube (n = 14). Respiratory and hemodynamic variables were recorded. Intraoperative and postoperative complications were noted. The respiratory rate and the end-tidal CO2 were significantly higher in the LMA group as compared with the ET tube group (P < 0.01); however, the pulse rate and both systolic and diastolic blood pressures throughout the surgical procedure were lower in the LMA group (P < 0.05). The incidence of coughing, with and without desaturation, wheezing, and hoarseness in the postoperative period was higher in the ET tube group. Awakening, after discontinuation of the anesthetic (P < 0.01) was more rapid, and home discharge time (P < 0.002) was shorter in the LMA group (P < 0.0025), although our study design could not isolate the use of the LMA as the factor responsible for this. This study in patients with mild chronic lung disease demonstrated that the LMA can maintain a satisfactory airway during minor surgical procedures in children with bronchopulmonary dysplasia and result in fewer respiratory adverse effects than with the ET tube.
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PMID:The use of the laryngeal mask airway in children with bronchopulmonary dysplasia. 861 21


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