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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Bicore CP-100 pulmonary monitor offers the advantage of continuous pulmonary monitoring at the bedside. Using an easily placed oesophageal balloon catheter and a flow transducer within the ventilator system, intrathoracic pressures, airway pressures and airway flow can be measured, and from these the Bicore calculates 25 other respiratory variables. The monitor screen displays real time waveforms of airway pressure, airway flow, oesophageal pressure and inspired tidal volume, and with these data it should be possible to determine more accurately when patients can be weaned from mechanical ventilation. It should also be possible to assess objectively the onset of respiratory fatigue and failure so that intervention can take place at an earlier stage. To assess the ease of use and potential benefit, the Bicore was used to calculate the work of breathing while weaning eight patients from mechanical ventilation in a spontaneous breathing mode. The pressure support ranged from 20 cmH2O, 10 cmH2O and 5 cmH2O, to a continuous positive airway pressure of 5 cmH2O, all with a positive end-expiratory pressure of 5 cmH2O, down to a single T-circuit with no positive airway pressure or end-expiratory pressure. The work of breathing while on a Veola Hamilton ventilator was found to be about the same, while receiving pressure support of 20 cmH2O compared to a continuous positive airway pressure of 5; the other forms of respiratory support increased the work of breathing significantly.
Anaesthesia 1993 Nov
PMID:The Bicore pulmonary monitor. A device to assess the work of breathing while weaning from mechanical ventilation. 825 Jan 98

This prospective study was designed to evaluate the sedative effect of two different anaesthetic drugs in patients undergoing ophthalmic surgery. Propofol is an intravenous hypnotic agent with a short half-life of about 30 min. A constant high oxygen saturation in continuous pulse oximetry was achieved in previous studies using propofol for sedation. Furthermore, an IOP-lowering effect was proved. Propofol was compared to diazepam, a well-established sedative, which has been used for many years for sedation of patients in local anaesthesia. METHOD. One hundred patients of comparable anaesthesiologic risk (ASA classes 2-4) undergoing identical surgical procedures received either propofol (n = 50), or diazepam (n = 50). Propofol was infused at a rate of 0.8-3.0 mg/kg/h, while diazepam was given as a slow intravenous bolus of 5 mg before surgery. All patients were monitored by continuous pulse oximetry. RESULTS. Oxygen saturation of patients receiving propofol was never less than 96%. In contrast, oxygen saturation of patients sedated by diazepam dropped to 85%, especially for the first 5 min following administration, before improving to 95% during the next 10 min. None of the patients who received propofol showed signs of motor unrest, a great handicap in ophthalmic surgery, while four patients who received diazepam were restless enough to hamper the procedure. None of the patients who received propofol developed respiratory depression. In contrast, marked respiratory depression, motor agitation, and postoperative fatigue slowing mobilization were common in patients who received diazepam.
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PMID:[Propofol versus diazepam. Sedation in ophthalmologic surgery under local anesthesia]. 827 89

Pregnancy is certainly an option open to patients with myasthenia gravis. Preconceptional counseling is the ideal, with the goal of discontinuing or reducing corticosteroid medications in patients requiring those agents. Alterations in physiology will require ongoing and careful assessment of the pregnant myasthenic or cholinergic crises. Antenatal testing for fetal well-being may be difficult to interpret. A small number of fetuses with fetal myasthenia gravis will be diagnosed by ultrasound. Attempts may be made to decrease the amount of circulating antibody crossing to the fetus. Interventions may include starting or increasing corticosteroid therapy, therapy with azathioprine, or plasmapheresis. Thymectomy is usually not performed during pregnancy. The intrapartum period will increase fatigue in the mother and may precipitate a myasthenic crisis. Epidural anesthesia is currently the agent of choice for decreasing pain and fatigue. An outlet forceps or vacuum delivery will shorten the second stage of labor in those patients who are unable to push repetitively. Cesarean delivery is preferably avoided in those patients at risk for pulmonary and thrombo-embolic complications. Narcotic and sedative medications may be used in the presence of careful and continuous assessment; they may increase respiratory and muscular symptoms. The postpartum period may be associated with an increase in exacerbations. Support services may help to eliminate or to reduce potent stressors during this time. Medication dosages may need to be adjusted as the mother's body returns to her prepregnant state. Transient, neonatal myasthenia is seen in up to 21% of maternal myasthenic cases, even in those patients with no detectable circulating antibody.
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PMID:Myasthenia gravis and pregnancy. 833 87

The initial clinical findings that form the basis for the diagnosis of puerperal SSSVT are frequently quite subtle. It is essential to a favorable outcome that clinicians maintain a high index of suspicion in relation to physical complaints of puerperal women. Meticulous, comprehensive, multisystem assessment is indicated to explore fully the presentation of headache, weakness, or other subjective data when discovered. Headaches can easily be attributed to a multitude of factors associated with birth. These include fatigue, stress, complications of anesthesia, fluid and electrolyte imbalances, and muscle tension and strain. It is imperative that clinicians not assume a benign etiology for headache. Rather, ongoing assessment focused on describing the problem in its entirety is indicated. Irritability, too, can easily be attributed to stress and exhaustion. Ongoing evaluation of responses to medication, nutrition, and rest will prevent overlooking a fulminant process such as SSSVT. Patients frequently need advocates when symptoms are vague and inconsistent. Careful documentation of findings as well as open, ongoing communication with members of the clinical team will best serve the patient. Retrospective analysis of vague complaints and subtle clinical findings frequently forms the basis for diagnosis of SSSVT and for clinical management to follow. In the face of cost constraints and restrictive third party reimbursement, there is significant incentive for early discharge. For this reason, identifying fulminant processes is an increasingly significant role of the perinatal nurse. Data collected in routine assessments and then verified and aggregated by the members of the health care team will be critical to prevent a rise in morbidity and mortality in the early days following discharge. In a more hopeful tone, detecting and resolving complications will help to set up the newly established family for a positive start. Quite simply put, a healthy woman has more energy to take on the new role of mother and maintain her present roles of wife, mother, worker, member of a family, and member of a community.
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PMID:Perinatal superior sagittal sinus venous thrombosis. 833 89

More than 410,000 people participated in the National Marrow Donor Program (NMDP) as of October 1, 1991, and more than 850 volunteers had donated marrow. While the incidence of serious morbidity as a result of bone marrow donation is rare, the incidence of lesser complications and the long-term consequences of marrow donation are not known. To determine the incidence of donor complications and measure the recovery time of volunteer, unrelated marrow donors, we analyzed the results of surveys of the first 493 persons who donated marrow through the NMDP. The marrows were collected at 42 centers. The median age of the donors was 37.9 years (range 19.1 to 55.6 years). The median volume of marrow collected was 1,050 mL (range 180 to 2,983 mL). Autologous red blood cells were transfused to 89.8% (439) of donors but only 0.6% (3) of donors received allogeneic blood. Acute complications related to the collection procedure occurred in 5.9% of donors; but a serious complication, apnea during anesthesia, occurred in only one donor. When donors were questioned approximately 2 days following discharge from their hospitalization, most donors described symptoms related to the collection; 74.8% experienced tiredness, 67.8% experienced pain at the marrow collection site, and 51.6% of the donors experienced low back pain. Donors were surveyed repeatedly until they felt that they had recovered completely. Mean recovery time was 15.8 days; however, 42 (10%) donors felt that it took them > or = 30 days to recover fully. The duration of the marrow collection procedure and duration of anesthesia both positively correlated with donor pain and/or fatigue following the collection; but the duration of the collection procedure had the highest correlation with post-collection pain and fatigue. The volume of marrow collected per unit of donor weight was more weakly correlated with donor pain and/or fatigue than the anesthesia and collection times. When multivariate analysis was used to analyze the correlation between donor recovery time and these variables, only the duration of the collection was found to correlate significantly with donor recovery time (P = .001). This analysis demonstrates that marrow donation is well tolerated with few complications. To decrease further the incidence of donor discomfort and recovery time following donation, the duration of the collection procedure, and probably the duration of anesthesia, and the volume of marrow collected, should be kept to a minimum.
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PMID:Experiences of the first 493 unrelated marrow donors in the National Marrow Donor Program. 846 78

The purpose of this paper is to report an eight-hour operation in which anaesthesia was provided by a combination of continuous epidural analgesia and light general anaesthesia administered via a laryngeal mask. During the perioperative period, the respiratory system was monitored with arterial blood gas and thoraco-abdominal movement analyses. There was no deterioration in respiratory function nor evidence of respiratory fatigue. We suggest that this is a suitable technique in fasting healthy patients undergoing prolonged surgery to the extremities.
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PMID:The laryngeal mask airway and prolonged balanced regional anaesthesia. 848 96

Uncomplicated major surgery is followed by a pronounced increased feeling of fatigue extending throughout the first month in about one-third of patients. Postoperative fatigue correlates with the degree of surgical trauma but is not related to duration of general anesthesia and surgery or to preoperative nutritional status, age, or sex. Fatigue also correlates with postoperative deterioration in nutritional parameters and impaired adaptability of heart rate during exercise. Furthermore, a postoperative decrease in muscle force and endurance is related to postoperative fatigue, whereas psychological factors are of minor importance. These findings suggest postoperative fatigue to be mediated by the endocrine-metabolic response to surgery, impaired nutritional intake, or immobilization, but the relative role of these factors remains to be established. Until then, therapeutic measures against the development of postoperative fatigue should aim at reducing the surgical stress response, effective treatment of pain to facilitate mobilization, and exercise to increase postoperative nutritional intake.
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PMID:Postoperative fatigue. 851 17

The embouchure of the brass player is critical to tone production and largely depends on the integrity of the orbicularis oris muscle. Injury to this muscle can cripple the professional musician by causing fatigue, pain, and tonal deterioration. Ten brass players presented with muscular defects in the orbicularis oris muscle. Examination identified areas of abnormality within the muscle and electromyography (EMG) ruled out a neurologic deficit. All patients underwent exploration under neuroleptic anesthesia, and 9 patients underwent repair. The technique is described. The repaired patients reported improvement after the operation and all resumed playing at their premorbid level. The 10th patient was found to have thinning of the entire orbicularis oris muscle (presumably congenital) and was not able to be repaired. There were no complications of the procedure and no recurrences.
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PMID:Orbicularis oris muscle injury in brass players. 865 63

The effect on inhibiting the calcium activated neutral protease (CANP) by leupeptin on force output and motor unit size of the partially denervated rat EDL muscle was studied. Partial denervation was performed under anaesthesia by section of the L4 ventral ramus in 3- and 18-day-old Wistar rats. Two days after the operation a silicon strip containing the inhibitor of CANP leupeptin was implanted alongside the partially denervated EDL. Two to 3 months later the animals were anaesthetized and the EDL muscles on both sides prepared for tension recording. The results from these recordings show dramatic reduction in force output and muscle weight in animals operated at 3 days and this reduction was less pronounced in muscles treated with leupeptin. The mean force output of individual motor units increases in the leupeptin-treated partially denervated muscle compared to the untreated muscle. The increased fatigue resistance typical of muscles partially denervated at 3 days [37] is less pronounced in the treated muscle. In animals operated at 18 days the individual motor units actually increased in size and the leupeptin treatment had no effect on the partially denervated EDL muscles. The difference between the response to leupeptin of the 3 day and 18 day operated animals could be due to the different patterns of innervation of the muscles at the time of the application of the inhibitor of CANP.
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PMID:Stabilisation of neuromuscular junctions by leupeptin increases motor unit size in partially denervated rat muscles. 866 65

Posterior laryngeal granuloma is an infrequent pathology of multidisciplinary interest. Actually, its real prevalence is difficult to quantify because in some cases it is asymptomatic and in other instances it may either be reabsorbed or eliminated spontaneously. It is located at the vocal apophysis of the arytenoid or, less frequently, above it or on the laryngeal side of the arytenoid. The many etiologic factors (laryngeal intubation, gastro-esophageal refluxes, blunt trauma of the larynx, vocal dysfunction), sometimes concomitant and with the possible addition of enhancing circumstances (upper aerodigestive tract inflammation, naso-gastric tube, smoking and alcohol abuse), converge to a single pathogenetic mechanism: an ulceration of the mucosa and the pericondrium, sometimes complicated by an infection, which does not heal but instead produces a typical granulation tissue with capillaries oriented radially from the center of the lesion. Post intubation granulomas, extremely rare in children, are more frequent in females. It appears that there is no correlation with duration of intubation in that granulomas, can also occur after short general anesthesia. Idiopathic or contact granulomas are more frequent in the males. They are the result of vocal laryngeal hyperfunction, habitual throat clearing or cough-like throat clearing. Gastro-esophageal reflux of gastric juice, coughing or throat clearing may injure the mucosa. A blunt trauma of the larynx may cause a granuloma if the cartilage of the vocal process is exposed. Symptoms, when present, are dysphonia, tiredness during or after voicing, bolus, laryngeal unilateral pain, sensation of something in the throat which is mobile during breathing and swallowing, traces of blood in the expectoration. Therapeutic options are surgical, medical or logopedic. Surgery, although followed by frequent recurrences, is mandatory when the granuloma causes dispnea or if a pathologic essay is needed. Medical treatment aims at solving gastroesophageal reflux and/or inflammations of the district. Logopedic rehabilitation is the most successful therapy. Since January 1992 the Authors have been adopting the rehabilitation protocol planned by the French phoniatrician Brigitte Arnoux-Sindt for post-intubation granulomas, which, moreover, is utilyzed for all type of granulomas, including those arising during the early postoperative period after cordectomy. This protocol is analytically presented and discussed. In the cases of contact granulomas, and when there is concomitant vocal dysfunction, logopedic treatment is prolonged after granuloma dissapearance with some sessions aiming at restoring correct vocal behaviour. In all the ten patients rehabilitated up to now, granulomas disappeared after a mean of 16.3 sessions held twice a week. After several months of follow-up we had no recurrences. This clinical experience, while limited in number, seems to confirm the good results already reported in French Literature.
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PMID:[Logopedic rehabilitation of laryngeal granulomas]. 872 28


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