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Query: UMLS:C0020440 (hypercapnia)
 7,939 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three anaesthetic techniques based on isoflurane were compared in outpatients undergoing laparoscopy. Sixty healthy patients were randomly allocated to receive isoflurane via mask (spontaneous respiration), via tracheal tube (spontaneous respiration) or via tracheal tube with controlled ventilation. Moderate hypercarbia occurred in the group breathing from a mask, although there was no further increase during carbon dioxide insufflation and laparoscopy. No arrhythmias were seen during insufflation and surgical conditions in all groups were good. Spontaneous respiration via a face mask did not lead to significant hypercarbia, acidosis or cardiac arrhythmia. A high incidence of minor morbidity was found in all groups. Sore throat was much less frequent in the mask group, whereas the incidence of other after-effects, including muscle pains, did not differ significantly among the groups.
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PMID:Laparoscopy: blood-gas values and minor sequelae associated with three techniques based on isoflurane. 295 Sep 10

The frequency and pattern of laryngeal mask airway (LMA) usage in a regional general hospital has been studied. Data were collected prospectively by means of a standardized record sheet which was completed at the time of anesthetic administration. During a 19-month period 10,150 patients underwent surgical procedures requiring general or regional anesthesia, of which 1,096 (men/ women: 791/305, ASA 3 or 4: 350, mean age: 64 years) were managed with the LMA. A clinically pattern airway was provided in 99.75% of occasions of whom 44.4% breathed spontaneously and 55.3% underwent positive pressure ventilation. The monthly frequencies of LMA usage increased significantly during the second year of the survey (25.1% vs 12.8%). Problems were recorded in 16.3% of cases: air leak 8.0%, laryngospasm 1.8%, desaturation (SpO2 < or = 90%) 1.8%, severe hypercarbia (PETCO2 > or = 50 mmHg) 1.0%, regurgitation 0.09%, sore throat 3.4%. No patient required intensive care management postoperatively. There were five cases of failed intubation managed with the LMA. This survey has shown that LMA has a well established role in anesthetic practice. Use of this device is equally safe and effective for both controlled and spontaneous ventilation in a wide range of starve patients undergoing most types of surgery.
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PMID:The laryngeal mask airway: a survey of its usage in 1,096 patients. 903 36

Awake video-assisted thoracic surgery (VATS) has been increasingly employed in a variety of procedures involving pleura, lungs, and mediastinum. Adequate anesthesia and analgesia obtained from thoracic epidural anesthetic (TEA) allow VATS to be performed in awake patients. The potential general anesthesia-related adverse effects, such as intubation-related trauma, pneumonia, ventilator-associated lung injury, effects of neuromuscular blocking agents, and postoperative nausea and vomiting, can thus be avoided. Moreover, TEA holds the benefits of reducing pulmonary and cardiac morbidities and mortalities after noncardiac surgery. Patients who undergo awake VATS may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically-induced pneumothorax. Preliminary results from early case series have indicated certain benefits, including greater patient satisfaction, less nursing care, less sore throat, earlier resumption of oral intake, lower rate of morbidity, reduced perioperative pain, reduced cost, and shorter hospital stay. However, anesthesia for awake VATS presents a particular challenge to anesthesiologists and requires extra vigilance. Potential hazards include paradoxical respiration and mediastinum shift after surgery induced pneumothorax, which may cause progressive hypoxia, hypercapnia and hypotension. Anesthesiologists should be acquainted with the procedure to be performed, be knowledgeable on the physiological changes, be aware of the potential problems, and have good judgment on suitable timing for conversion of regional anesthesia to intubation general anesthesia in enforced circumstance.
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PMID:Anesthesia for awake video-assisted thoracic surgery. 2302 72

Coronaviruses cause disease in animals and people around the world. Human coronaviruses (HCoV) are mainly known to cause infections of the upper and lower respiratory tract but the symptoms may also involve the nervous and digestive systems. Since the beginning of December 2019, there has been an epidemic of SARS-CoV-2, which was originally referred to as 2019-nCoV. The most common symptoms are fever and cough, fatigue, sputum production, dyspnea, myalgia, arthralgia or sore throat, headache, nausea, vomiting or diarrhea (30%). The best prevention is to avoid exposure. In addition, contact per-sons should be subjected to mandatory quarantine. COVID-19 patients should be treated in specialist centers. A significant number of patients with pneumonia require passive oxygen therapy. Non-invasive ventilation and high-flow nasal oxygen therapy can be applied in mild and moderate non-hypercapnia cases. A lung-saving ventilation strategy must be implemented in acute respiratory distress syndrome and mechanically ventilated patients. Extracorporeal membrane oxygenation is a highly specialized method, available only in selected centers and not applicable to a significant number of cases. Specific pharmacological treatment for COVID-19 is not currently available. Modern medicine is gearing up to fight the new coronavirus pandemic. The key is a holistic approach to the patient including, primar-ily, the use of personal protective equipment to reduce the risk of further virus transmission, as well as patient management, which consists in both quarantine and, in the absence of specific pharmacological therapy, symptomatic treatment.
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PMID:COVID-19 challenge for modern medicine. 3228 79