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Query: UMLS:C0016382 (flushing)
 6,387 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To overcome the technical limitations which have precluded noninvasive Doppler ultrasound in investigation of rapid cerebral haemodynamic responses in two cerebrovascular beds at the same time, we have modified a commercial 2 MHz pulsed Doppler instrument with online spectrum analysis. Two probes are activated intermittently, recording eight averaged Doppler-shifted spectra from each probe sequentially. Concurrent recordings of blood velocity in both middle cerebral arteries were performed during 25 selective iohexol carotid angiography runs in 13 patients with near normal cerebral vasculature. The technique permitted the differentiation between the specific responses confined to the recipient vascular bed, and the general responses occurring in remote brain areas as well. The specific response to iohexol was biphasic; a significant decrease in blood velocity occurred less than 4 s after the bolus entry, probably due to the high viscocity of iohexol. Between 4 and 12 s. blood velocity was significantly increased, reflecting the cerebrovascular response to hypertonic solutions. The blood velocity on the opposite side increased from less than 4 s through 45 s after iohexol. This concurs with studies using electromagnetic flowmetry, and suggests that these general responses are elicited by anxiety, discomfort and pain. Thus, no general responses were seen during angiography under general anaesthesia. Eight patients investigated during catheter flushing with normal saline showed a biphasic specific response reciprocal to that due to iohexol. A significant blood velocity peak occurred less than 4 s after the bolus entry, followed by a decrease between 4 and 60 s. The saline injections produced no pain and evoked no significant general response.
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PMID:Haemodynamic aspects of clinical cerebral angiography. Concurrent two vessel monitoring using transcranial Doppler ultrasound. 212 5

Bier introduced his intravenous technique of local anaesthesia to facilitate palliative surgery on the elbow or knee. He cannulated a suitably large vein in the vicinity of the joint to inject procaine after first isolating the operating site with a proximal and a distal tourniquet. This extra containment of the local anaesthetic solution made it feasible to flush out any unfixed drug with saline before release of the main tourniquet, an advantage which has been lost in the currently fashionable technique of intravenous regional anaesthesia (IVRA) involving a single tourniquet above the elbow or knee and a fine butterfly needle in a vein on the dorsum of the hand or foot. A modern version of Bier's original method is described, conveniently called an intercuff block (ICB), which reintroduces the possibility of effective flushing, offers better operating conditions and engenders new ideas for further study.
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PMID:Bier's block revisited: intercuff block. 218 59

The incidence, presentation, and treatment strategies of abdominal carcinoid tumours are discussed. In the Trent Region of the UK, carcinoid tumours have an incidence of 0.7 cases/100,000 population. The small bowel is the commonest site (36%) followed by the lung (22%) and appendix (13%). Analysis of the presenting symptoms and signs in 24 cases of small bowel cancer demonstrated diarrhoea in 17, pain in 17, and flushing in 12. Treatment strategies comprise surgery and drug therapy. Sandostatin has a role in preventing the release of pharmacologically active tumour products. A long-term trial of Sandostatin in patients with carcinoid syndrome is underway. Experience to dat indicates Sandostatin is indicated: where surgery and drugs (cyproheptadine and codeine phosphate) in combination have failed to control symptoms; where the patient is unfit for surgery; and to cover anaesthesia and surgery as prophylaxis against the risks of carcinoid crisis.
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PMID:Abdominal carcinoid tumours in Sheffield. 233 66

A patient undergoing groin lymph node dissection with spinal and general anaesthesia was receiving enalapril to control hypertension. Infusion of stable plasma protein solution (Commonwealth Serum Laboratories, Australia) was associated with significant hypotension and flushing. A brief review of stable plasma protein solution and angiotensin converting enzyme inhibitor pharmacology is presented to provide a possible mechanism for these events. This mechanism implies that angiotensin converting enzyme inhibitor therapy is a relative contraindication to rapid SPPS infusion.
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PMID:Possible interaction between SPPS and enalapril. 233 34

The physiologic effects of 12-hour lung preservation were assessed in six mongrel dogs studied for 20 hours after double-lung allograft implantation. Donor animals were pretreated with allopurinol (30 mg/kg) and methylprednisolone (500 mg) intravenously at anesthesia induction. Heart-lung blocks were harvested after cardioplegic arrest, and a simple pulmonary artery flush of 4 degrees C modified Collins' solution was administered at 15 ml/kg/min. The lungs were ventilated with 100% nitrogen during flushing and inflation. Recipient animals received an infusion of deferoxamine (20 mg/kg) during implantation and were pretreated with methylprednisolone (500 mg) intravenously. All six implantations were technically successful. Two animals died of cardiac standstill 12 and 24 hours postoperatively. Gas exchange deteriorated after implantation compared with donor levels but remained in a range compatible with survival, and at 20 hours arterial oxygen tension (FiO2 0.4) was 138 +/- 91 mm Hg. Similar changes were seen in alveolar-arterial oxygen gradients and arterial-alveolar oxygen tension fraction. Elimination of carbon dioxide was satisfactory. Pulmonary venous shunt fraction rose significantly at the end of the study. Hemodynamic changes consisted of a gradual increase in pulmonary vascular resistance and a reduction in cardiac output. Lung mechanics also deteriorated, with a gradual rise in airway resistance and a fall in compliance. The double-lung model allows detailed assessment of the early effects of preservation and may have certain advantages over heart-lung models of preservation. The preservation technique warrants further study.
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PMID:Acute physiologic changes after extended pulmonary preservation. 235 75

When performing vasectomies, surgeons should have 3 goals: 1) to reduce the failure rate due to spontaneous reanastomosis from current levels of 1 in 100 to 1 in 1000, 2) to prevent complications such as hematoma through the use of autramatic plastic surgical instruments, and 3) to maximize the potential for future microsurgical reversal. Achievement of these aims requires an understanding of the region, magnification for the identification of tissue layers, and sterile instruments. Although each vasectomist makes minor variations in technique, there are certain rules that should always be followed: do not use local anesthesia with adrenalin inside the scrotum, avoid testicle strangulation by not rotating the testicle 180 degrees out of normal alignment or operate on one side twice, do not use black braided silk sutures on Fallope rings inside the scrotum, use cremasteric fascial separation of the cut vas ends to prevent spontaneous reanastomosis, leave the testicular end open to the scrotum to reduce back pressure on the epididymis, use a water rather than spirit-based skin antiseptic, and adhere to all sterile procedures. The author outlines the steps involved in vasectomy, from preoperative assessment, skin preparation, anesthesia, isolation of the vas, incision, identification of the vas in the sheath, securing the cremasteric sheath, isolating only the vas, flushing the vas, severing the vas, cautery, open ended vasectomy, to skin closure. Also presented are guidelines for the postoperative period and the management of complications such as bleeding, hematomas, infection, adhesions, epididymitis and sperm granuloma, and neuritis.
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PMID:Vasectomy technique. 240 10

We determined the dose-response relationships of mivacurium (BW B1090U) in children (2-10 years) during nitrous oxide-halothane anesthesia (0.8% end-tidal) and during nitrous oxide-narcotic anesthesia. Neuromuscular blockade was monitored by recording the electromyographic activity of the adductor pollicis muscle resulting from supramaximal stimulation at the ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. To estimate dose-response relationships, for each anesthetic background four subgroups of nine patients received single bolus doses of 20-120 micrograms/kg mivacurium. The ED50 and ED95 (estimated from linear regression plots of log-dose vs. probit of effect) were 52 micrograms/kg and 89 micrograms/kg during halothane anesthesia and 62 micrograms/kg and 103 micrograms/kg during narcotic anesthesia. Nine additional patients in each anesthetic group received 250 micrograms/kg mivacurium. Three of the 18 patients given 250 micrograms/kg mivacurium developed cutaneous flushing; in one of these mean arterial pressure decreased 32% for less than 1 minute; no significant changes in heart rate occurred. With the increase in mivacurium dose from 120 micrograms/kg to 250 micrograms/kg the times to onset of 90% and maximum neuromuscular block decreased by 0.5 to 1 minute, and the times to recovery of neuromuscular transmission to 5% (T5) or 25% (T25) increased by 2-4 minutes. The recovery index (T25-75) in patients anesthetized with halothane was 4.3 +/- 1.5 minute (mean +/- SD); the time to complete recovery (T4:1 greater than or equal to 0.75) was 19.8 +/- 7.4 minutes.
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PMID:Clinical pharmacology of mivacurium chloride (BW B1090U) in children during nitrous oxide-halothane and nitrous oxide-narcotic anesthesia. 252 47

The ability of three different techniques of transtracheal ventilation to reverse hypoxia and provide pulmonary ventilation were examined. Five swine were anaesthetized with isoflurane in oxygen, their tracheas were intubated, and their lungs mechanically ventilated to produce a PaCO2 of 35-40 mmHg. A 14-gauge catheter was inserted percutaneously into the trachea caudad to the tip of the tracheal tube. The animals were then left apnoeic until their oxygen saturation fell to 60 per cent. At this point, attempts were made to ventilate and oxygenate the animals through the tracheal catheter with one of three systems (Jet--50 psi [2585 mmHg] driving pressure controlled with a thumb operated valve, Flush-fresh gas outlet of an anaesthetic machine with flow controlled by the flush button, or Circle--standard anaesthesia circle system with pressures greater than 60 mmHg). Arterial blood gas determinations were made every minute for five minutes after beginning transtracheal ventilation. Both the Jet and Flush modes resulted in a mean PaO2 greater than 250 mmHg within one minute of their initiation whereas the PaO2 with the Circle system never exceeded 180 mmHg even at five minutes. The Flush and Jet modes produced a decrease in the PaCO2 (from 80 mmHg to 35-45 mmHg) over the five minutes. In contrast, it was not possible to provide adequate ventilation with the Circle system as evidence by an increasing PaCO2 (from 80 mmHg to less than 110 mmHg at five minutes).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The efficacy of three different methods of transtracheal ventilation. 258 61

There were three cases of pulmonary barotrauma during anesthesia. The causes of barotrauma were: 1) Undue length of the tube pressed by machine's wheel which connect the ventilator to the anesthesia machine. 2) Inadvertent connection of the breathing tube to the inspiratory side of the machine when using the Bain system. 3) Inadvertent placement of expiratory valve. All resulted in obstruction to air outflow. The condition further aggravated by repeated flushing of the oxygen flush valve, leading to rapid increase in intraluminal pressure and rupture of alveolar. The condition can be rapidly recognized by palpation of the neck, auscultation of breathing sound, and finally, with a portable chest X-ray. When any problem exists in the breathing system of anesthesia machines, disconnecting the patient from the machine is mandatory. The patient can be ventilated with an Ambu bag while checking the system thus lessening the incidence of barotrauma.
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PMID:[Pulmonary barotrauma during anesthesia]. 263 22

Pharmaseal continuous flushing devices were tested with regard to flow characteristics into simulated arterial and venous pressure systems. Two driving pressures were used and it was found that variation in driving pressure made a significant difference to the flow, while arterial or venous pressure made no significant difference. The flow devices had a wide variation although they were all of the same type. The fluid volume delivered was in the region of 100 ml in a 24-hour period.
Anaesthesia 1989 Mar
PMID:Characteristics of the Pharmaseal continuous flushing device. 270 12


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