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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report here on a case of primary alveolar hypoventilation in a 9 yr old child. From the age of 8 years, the patient has suffered from episodes of bronchopneumonia associated with severe respiratory insufficiency and lethargy. After recovery, cyanosis developed during the night and, later on, during the day. On two occasions, serious respiratory depression followed ketamine sedation for cardiac catheterization and total anaesthesia for cerebral angiography. Pulmonary function tests showed normal volumes and normal mechanics of breathing; blood gas analysis revealed a slight hypercapnic acidosis and hypoxia. The ventilatory response to CO2 was virtually absent, whereas voluntary hyperventilation normalized blood gas values. A polygraphic recording during sleep showed a marked worsening of hypoventilation, which occurred soon after falling asleep and continued throughout all sleep stages; sporadic central apnoeas, at times prolonged, were recorded only during light sleep. The patient, now 14 yr old, is maintained in satisfactory condition with low flow nocturnal oxygen administration combined with the use of a body respirator during sleep twice a week.
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PMID:A polygraphic study of one case of primary alveolar hypoventilation (Ondine's curse). 672 66

Acid-base status of arterial blood was measured in chronically cannulated, unanesthetized, unrestrained guinea pigs. Normal values were: pH = 7.444 +/- 0.032; PaCO2 = 35.7 +/- 4.4; HCO3- = 24.4 +/- 2.8; BE = +0.4 +/- 2.1 (n = 69) and PaCO2 = 91.9 +/- 7.3 (n = 25) (Values are mean +/- S.D.). Induction of light anesthesia with thiopentone caused a respiratory depression (decrease in PaO2) accompanied by respiratory acidosis (increase in PaCO2 and decrease in pH) and a development of slight metabolic acidosis (decrease in base excess and standard bicarbonate). Acid base parameters of guinea pigs are compared to those obtained from rats under identical experimental conditions.
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PMID:Acid base status in unanesthetized, unrestrained guinea pigs. 677 Mar 39

The cardiopulmonary effects and tendencies to produce ventricular arrhythmias were evaluated in 13 dogs given a surgical plane of anesthesia by thiopental (IV) or a combination of thiopental and lidocaine (IV). Thiopental (22 mg/kg of body weight) was compared with a combination of thiopental (11 mg/kg) and lidocaine (8.8 mg/kg). Preanesthetic agents were not given. Both methods for IV anesthesia provided a smooth induction suitable for easy intubation. The thiopental/lidocaine combination had a shorter duration, produced no arrhythmias, and resulted in less cardiopulmonary depression than did thiopental alone. Bigeminy developed after intubation during 19 of 20 thiopental inductions as compared with that in 0 of 22 thiopental/lidocaine inductions. The bigeminies were preceded by systemic hypertension and tachycardia which developed as the trachea was being intubated. The increase in aortic pressure and heart rate was minimal after intubation during the thiopental/lidocaine inductions. Five minutes after administration of thiopental alone, increases in heart rate, aortic pressure, total peripheral vascular resistance, and left ventricular systolic and end-diastolic pressures were observed. When these increases in rate, preload, and afterload were considered in relation to a stabile maximum positive first derivative of left ventricular pressure, left ventricular contractility was considered to be decreased. Mild respiratory acidosis and hypoxemia were present at 5 and 10 minutes after thiopental induction. Because the combination of thiopental/lidocaine had less cardiopulmonary depressive effects and protected against arrhythmias, it would appear to be a good method for anesthetic induction of the patient with cardiopulmonary disease. In the patient with normal cardiopulmonary function, thiopental produces only a moderate and reversible depression.
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PMID:Cardiopulmonary effects of thiopental/lidocaine combination during anesthetic induction in the dog. 682 18

Three consecutive cases of myxedema coma treated successfully with either nasogastric or intravenous route of administration of I-triiodothyronine, followed by oral thyroxine, are described. All were hypothermic, had biochemical evidence of advanced hypothyroidism (T4 less than 1.0 micrograms/dl, T3 less than 20 ng/dl and TSH greater than 150 microU/ml), severe hypoxemia, respiratory acidosis, hypercarbia and temporary depression of respiratory center responsiveness. In only one patient it was found significant hyponatremia (Na = 127 mEq/l). Two patients were successfully treated with the nasogastric route of administration of T3 (12.5 micrograms/6h) but in a female patient with intestinal atony (ileus) there was no absorption of the orally administered T3. Intravenously administered T3 promptly corrected the hypometabolic state in this patient. It was confirmed that T4 therapy, although promptly correcting low serum T4 concentration, failed to rise serum T3 levels due to lack of peripheral T4 5'-monodeiodination to T3 in these critically ill patients.
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PMID:Management of myxedema coma: report on three successfully treated cases with nasogastric or intravenous administration of triiodothyronine. 715 77

Propanidid, etomidate, and ketamine were compared for their effects on maternal acid-base balance and circulation as well as on postnatal general condition and acid-base balance of the newborn, on the basis of 44 women in advanced pregnancy to whom caesarean section was applied in general anaesthesia. The probands had not been deliberately selected beforehand. Results obtained from the three above anaesthetics were compared with one another as well as with parameters recorded from spontaneously delivered newborns without any medication. One of the anaesthetics produced sufficiently deep anaesthesia in all patients, and no signs of central depression were recordable from the newborns. The parameters of acid-base balance, following propanidid and etomidate anaesthesia, revealed respiratory acidosis in the newborns immediately after delivery by caesarean section. Their pH values were lower than those recorded in the context of ketamine anaesthesia or spontaneous delivery without any medication. Both values returned to normal within 30 minutes from delivery. The one-minute and five-minute Apgar scores were below those of spontaneous deliveries, at the beginning, but eventually reached normal levels. All the three anaesthetics were found to be suitable for introduction of general anaesthesia for caesarean section on account of high-rate enzymatic degradation and, consequently, absence of foetal depression. Resulting oxygen supply is higher, as compared to spontaneous delivery. Early indication and short-time introduction and delivery, thus possible, have often proved to be important to the newborn's condition.
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PMID:[Comparison between ketamine, propanidid, and etomidate in general anaesthesia for caesarean section (author's transl)]. 723 13

In hamsters, the entrance into hibernation is associated with a respiratory acidosis and elevation of the blood plasma concentrations of potassium, calcium, and magnesium. To investigate the effects of presumed hibernation-related ionic changes in the brain interstitium on neuronal function, the transmission properties of hippocampal slices prepared from golden hamsters were studied at low temperatures in vitro. Slices were investigated at 15-20 degrees C in artificial cerebrospinal fluid (ACSF) of variable composition (K+, 3-5 mM; Ca2+, 2-4 mM; Mg2+, 2-4 mM; pH 7.0-7.7). Population action potentials (population spikes, PS) of CA1 pyramidal cells were continuously evoked with 100-microseconds stimulus pulses delivered to the Schaffer collaterals/commissural fibers in intervals of 30 s. The PS amplitude was measured as a function of extracellular ion concentrations at given temperatures or as a function of temperature at a given ACSF composition. Elevation of [K+]o, [Mg2+]o, or [H+]o all reduced the PS amplitude at low temperatures, whereas elevation of [Ca2+]o increased the PS amplitude. In conclusion, changes in the ionic microenvironment occurring during entrance into hibernation presumably result in depression of synaptic transmission at low temperatures in the hamster hippocampus. The modulatory effect of ionic changes may be an important factor supporting a general depression of the brain during entrance into hibernation.
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PMID:Modulation of synaptic transmission at low temperatures by hibernation-related changes in ionic microenvironment in hippocampal slices of golden hamsters. 765 68

Inhibition of red cell carbonic anhydrase (CA) activity resulted in the rapid development of a respiratory acidosis (0.25 pH depression within 15 min post-injection) in the blood of trout. In the lamprey, however, the onset of the respiratory acidosis was delayed and its magnitude was less (0.18 pH depression at 6 h post-injection). Erythrocyte pH of both species decreased by about 0.12 units by 1 h after CA inhibition. These data, combined with the lack of rapid anion (Cl-/HCO3-) exchange in the red cells of agnathans but not in other lower vertebrates, support the hypotheses that (1) the majority of total CO2 in lamprey is transported within the erythrocyte, and (2) the limiting step in the evolution of a functioning Jacobs-Stewart cycle, and thus the evolution of the common mechanism of systemic CO2 transport in vertebrate blood, was the incorporation of the band-3 anion exchange protein into the membrane of the red cell.
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PMID:Effects of carbonic anhydrase inhibition on the acid base status in lamprey and trout. 777 7

Before the advent of curare, muscular relaxation essential for upper abdominal and intrathoracic surgery adequate operating conditions, could only be provided by deep ether or cyclopropane anaesthesia. The required depth of anaesthesia frequently caused severe cardiovascular depression, metabolic and respiratory acidosis and alteration of kidney and liver function. Ether, and especially cyclopropane sensitized the heart to the development of arrhythmias and the danger of explosion was never far away. For fear of anaesthetic mortality essential, life saving operations were often abandoned in poor risk patients. The administration of anaesthesia was more an art, mastered by relatively few, than a science that could be taught to many. It is a tribute to the early masters of anaesthesiology that they were able to carry their patients through the dangers associated with the provision of anaesthesia for major surgical procedures, with relatively low morbidity and mortality. The introduction of curare into anaesthetic practice, by Griffith and Johnson, in 1942, caused profound changes in the efficacy and safety of anaesthesiology. It made possible the development of true balanced anaesthesia, and the elimination of the explosive inhalation anaesthetics and the profound metabolic disturbances associated with their use. The concept of "inoperability," due to severe pathology or extremes of age became obsolete. It would be hard to envisage how open heart, organ transplant and radical brain and cranio-facial surgery could have developed without muscle relaxants.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Anesthesia before and after curare]. 828 Mar 40

This study has examined the acute haemodynamic effects of 7% sodium bicarbonate solution 1 mmol kg-1 (1.2 ml kg-1) administered into the right atrium over 5 s in 25 anaesthetized dogs allocated randomly to respiratory (arterial pH (pHa) 7.18, PaCO2 10.1 kPa (n = 8)) or metabolic acidosis (pHa 7.27, base deficit -9.0 mmol litre-1 (n = 7)) or metabolic neutrality (pHa 7.39 (n = 10)). The pHa and PaCO2 in the respiratory acidosis group differed from those in the two other groups (P < 0.01). One dog with respiratory acidosis developed progressive circulatory depression and cardiac arrest 6 min after injection of sodium bicarbonate. In the remaining seven dogs with respiratory acidosis, administration of sodium bicarbonate 1 mmol kg-1 produced transient decreases in mean arterial pressure, right ventricular dP/dt, and pulmonary blood flow, with increased right atrial pressure, followed by a gradual return of these variables to the baseline. The magnitude of reduction in pulmonary blood flow after sodium bicarbonate was greater in dogs with respiratory acidosis (P < 0.05) compared with the changes in the two other groups. The haemodynamic depression after bicarbonate was pronounced during respiratory acidosis and this may be attributed to a smaller pHa in the respiratory acidosis group, further reduction of intracellular pH, or both. It is suggested that when metabolic acidosis is corrected, bicarbonate should be administered with caution in the presence of respiratory acidosis.
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PMID:Acute haemodynamic effect of sodium bicarbonate in canine respiratory or metabolic acidosis. 838 74

Carbon dioxide is the most commonly used gas for abdominal insufflation in laparoscopy today. Due to the solubility of carbon dioxide large volumes are absorbed into the circulation causing a high PCO2 and a low pH (respiratory acidosis). Carbon dioxide is also stored in several sites in the body and is released at the conclusion of the procedure prolonging the respiratory acidosis when the patient is least able to cope with this additional burden. Cardiac effects of CO2 consist of a lowering of the arrhythmia threshold, increased blood pressure, pulse and cardiac output. At a sustained high level this can lead to cardiac depression and death. These effects are particularly prone to occur in cardiac and respiratory cripples. Other gases that have been used include air, oxygen, nitrous oxide and nitrogen. Their use has been discontinued because of the danger of embolism. Air, oxygen and nitrous oxide are also not safe to use in the presence of electrosurgical instruments thereby limiting their usefulness even further. Helium has been proposed as a very promising alternative to CO2. In the laboratory and in a clinical trial, helium has not produced the respiratory acidosis associated with CO2 insufflation. This is further evidence that the acidosis is not primarily due to elevation of the diaphragm and consequent increased dead space, but to the large amount of CO2 that is absorbed directly from the peritoneal cavity. Helium would seem to be the gas of choice at this time as it comes close to fitting the criteria for an ideal insufflating gas. Helium is clear and colorless, allowing unimpeded vision to the operator. It is non toxic, not flammable or explosive and can be safely used with electrocautery and laser. Helium is easy to handle and not very soluble which decreases the amount absorbed from the peritoneal cavity and consequently the amount used. That which is absorbed is quickly cleared by the lungs. Helium is metabolically inactive (in contrast to CO2) and does not interfere with normal metabolic processes. In view of this promising initial work, further studies are indicated.
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PMID:Helium insufflation in laparoscopic surgery. 884 34


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