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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Laser technology and the endoscope have been combined for the palliation of obstructive tracheobronchial malignant lesions. The neodymium-yttrium-aluminum-garnet (Nd-YAG) laser was used to treat 249 patients (447 operations), and the CO2 laser was used on 34 patients (59 operations). Hemorrhage, the major complication in both groups of patients, was more easily controlled with the Nd-YAG laser. One patient in the CO2 laser group died, and one patient in the group being treated with Nd-YAG laser bronchoscopy died. The Nd-YAG laser can be applied more efficiently through a fiber system, with better optic control and secure hemostasis. The commonest indications for treatment were dyspnea, obstructive pneumonia, and hemoptysis. Extrinsic compression was the most frequent reason for failure. The Nd-YAG laser, most often applied through open rigid bronchoscopes under general anesthesia, has become our treatment of choice for the palliation of tracheobronchial malignancy.
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PMID:Endoscopic treatment of tracheobronchial malignancy. Experience with Nd-YAG and CO2 lasers in 506 operations. 258 Dec 12

After anterolateral thoracotomy, before incision closure, indwelling plastic catheters were inserted percutaneously under digital and/or visual control into the intercostal space of access and the two neighbouring ones. Initially, we injected 25 mg of bupivacaine through each catheter (to a total of 75 mg), and subsequently - on the patients demand - another 15 to 25 mg per catheter. To date, 25 patients received repetitive intercostal nerve blocks by this method (ICB-group). We compared their personal and perioperative data with those of another 30 patients, receiving opiates systemically after major thoracic surgery (SA-group). Multiple blood samples from the ICB-group were analyzed by gaschromatography for bupivacaine concentration-time-profiles. In 19 of 25 patients (76%) the bupivacaine-injections provided sufficient analgesia, 6 patients required additional analgesics. The duration of general anaesthesia (ICB: 174 min vs. SA: 136 min) and the operation time (ICB: 103 min vs. SA: 94 min) were not statistically different in both groups. The periods of intensive care therapy (ICB: 0.7 d vs. SA: 1.2 d), artificial respiration (ICB: 11.2 h vs. SA: 21.6 h) and hospital stay (ICB: 12.1 d vs. SA: 14.2 d) were shorter for the ICB-group. Atelectasis (ICB: 20% vs. SA: 37%) and pneumonia (ICB: 0 vs. SA: 13%) were observed less frequently than in the control group, whereas tachyarrhythmia occurred in 6 of 25 ICB-patients compared to 4 of 30 SA-patients. Nevertheless, none of these parameters reached statistical significance (p less than 0.05). Maximum bupivacaine levels of 0.65 +/- 0.21 micrograms/ml were found after 29 +/- 12 min of intercostal application.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Repetitive intercostal nerve block via catheter for postoperative pain relief after thoracotomy. 258 43

Gastro-oesophageal reflux during a 40-minute reflux provocation test was assessed by lower oesophageal pH monitoring in 25 pregnant women at term, and again on about the second day after delivery. At term 17 women refluxed a total of 29 times; after delivery five women refluxed once each. There was a significant decrease in gastro-oesophageal reflux by the second day after delivery (p less than 0.05). Gastro-oesophageal reflux is, however, only one of the factors that predisposes to acid aspiration pneumonitis.
Anaesthesia 1989 Oct
PMID:Gastro-oesophageal reflux in pregnancy at term and after delivery. 258 5

A 12 month old boy weighing 6.4kg with esophageal varices caused by congenital biliary hypoplasia was scheduled for emergency sclerotherapy under general anesthesia. Anesthesia was induced with thiamylal sodium 3mg.kg-1 i.v. and then maintained with nitrous oxide, oxygen and a low concentration of enflurane, paralysed with pancuronium bromide. As soon as a small dose of sclerosant (5% ethanolamine oleate) was injected, transient moderate bradycardia and hypotension occurred. As his spontaneous breathing was very weak and the movements of extremities convulsive and his consciousness drowsy, prophylactic respiratory care was carried out. He had pneumonia and manifestation of DIC 4 days after sclerotherapy. He died of a massive tracheal hemorrhage. The cause of the patient's death seemed largely due to the several toxicities of sclerosant itself. We stress that although this therapy is effective for the child with portal hypertension, the incidence of complications might be high in patient with severely damaged liver function. Therefore, anesthetic and postoperative management in injection sclerotherapy should be performed very carefully.
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PMID:[Death after delayed recovery and respiratory failure following injection sclerotherapy in a small infant under general anesthesia]. 261 9

Midazolam hydrochloride is an ultra-short acting benzodiazepine recently approved by the Food and Drug Administration for anesthesia induction and preoperative sedation. Frequently, midazolam is also used as an injection or infusion for the treatment of agitation in ventilator-dependent patients. A 53-year-old man underwent a gastrojejunostomy and was later intubated following the development of pseudomonal pneumonia. Midazolam was initiated in an effort to resolve his agitation and the patient continued to receive frequent bolus injections, averaging 22 mg/d over 21 days. Approximately eight hours after midazolam was abruptly discontinued, the patient became increasingly anxious and developed somatic complaints felt to be consistent with benzodiazepine withdrawal syndrome. Symptoms rapidly abated upon the reintroduction of midazolam and the drug was ultimately tapered over a period of four days and discontinued without further incident. Implications derived from the association of long-term midazolam therapy with benzodiazepine withdrawal syndrome are discussed.
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PMID:Precipitation of benzodiazepine withdrawal following sudden discontinuation of midazolam. 272 5

Fifty patients undergoing closed and open heart surgery were prospectively studied for the effectiveness of peri-operative prophylaxis with Ceftriaxone. Twenty-four patients (Gr I) that underwent closed heart surgery received 50 mg/kg single dose of Ceftriaxone given intravenously at the start of anesthesia. Twenty-six patients (Gr II) that underwent open heart surgery received 50 mg/kg. Ceftriaxone given intravenously at the start of anesthesia followed by another 50 mg/kg 24 hours later. The mean duration of surgery in Gr I was 1.7 hours and Gr II was 4.2 hours. The duration of post-operative fever in Gr I ranged from 0-4 days (mean 2.4) and Gr II ranged from 1-13 days (mean 6). The duration of post-operative hospitalization in Gr I ranged from 5-18 days (mean 9) and Gr II ranged from 7-71 days (mean 19). Early and late infectious complications were not found in Gr I. Late infectious complications were not found in Gr I. Late infectious complications in Gr II consisted of 2 cases of pneumonitis, 5 pleural effusions and 1 staphylococcus aureus would infection (36.8%). We concluded that a single dose of Ceftriaxone should provide adequate prophylaxis for closed heart surgery. An additional 2-3 days of daily dose Ceftriaxone may be needed when associated with tissue hypoxia, longer duration of intravenous lines and drainage tubes in open heart surgery.
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PMID:Ceftriaxone prophylaxis in cardiovascular surgery in children. 273 5

The smoking of clove cigarettes has been associated with 13 cases of serious illness in the United States, including hemorrhagic pulmonary edema, pneumonia, bronchitis, and hemoptysis. We describe a patient in whom, after she smoked a clove cigarette, pneumonia complicated by lung abscess developed. Her lung disease may have been caused by aspiration pneumonia as a consequence of pharyngolaryngeal anesthesia from clove cigarette smoke. Clove cigarettes appeal to adolescents experimenting with smoking practices and may influence the development of later smoking habits.
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PMID:Clove cigarettes. The basis for concern regarding health effects. 277 82

This placebo-controlled trial compared the effects of preoperative, intravenous cimetidine (300 mg) or ranitidine (50 mg) on gastric pH and gastric volume in 31 adult patients requiring general anesthesia. The elapsed time from drug administration to initial gastric sampling did not differ significantly between ranitidine (45 minutes), cimetidine (48 minutes), or placebo (52 minutes) treated patients. Ranitidine, but not cimetidine, significantly (P = 0.02) increased gastric pH when compared with placebo. Gastric pH correlated (r = 0.7, P = 0.01) with cimetidine concentration in gastric fluid at induction. Gastric pH was directly proportional to ranitidine concentration in gastric fluid at induction, but the correlation was weak (r = 0.54, P = 0.1). The H2 blockers did not significantly alter gastric volume when compared with placebo. The number of patients with gastric pH less than = 2.5 and gastric volume = greater than 25 ml did not differ significantly between cimetidine (8%), ranitidine (10%), and placebo (22%). No clinical evidence of aspiration pneumonitis was found in our study patients.
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PMID:Single-dose intravenous H2 blocker prophylaxis against aspiration pneumonitis: assessment of drug concentration in gastric aspirate. 277 28

The case is reported of a 42 year old female patient with Graves disease who presented with an atypical thyroid storm after subtotal thyroidectomy. Surgery was indicated because of poor patient compliance with the medical treatment, and its partial failure. High doses of propranolol (240 mg a day) were given for 5 days preoperatively. Anaesthesia and surgery were uneventful however, towards the end of the first postoperative day, a severe myopathic syndrome started, with neither fever nor tachycardia. Respiratory failure and pneumonia occurred 24 h later. This was deemed to be due to an atypical thyroid storm. The patient was intubated and ventilated, and treated with high doses of propranolol (320 mg a day). Muscle strength began returning to normal on the 4th postoperative day, being completely normal 2 months later. Even though a particularly severe form of thyrotoxic myopathy appeared to be the most likely cause of this temporary muscle disorder, beta-blockers may have been involved. Their potential role is discussed.
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PMID:[Postoperative thyrotoxic crisis during beta blockade: an atypical picture of generalized muscle deficiency]. 281 46

The value of taking microbiological and cytological specimens by flexible bronchoscopy and bronchoalveolar lavage under local anaesthesia was assessed on 43 occasions in 35 HIV infected children, aged 3 months to 16 years, with interstitial pneumonitis. In acute interstitial pneumonitis (n = 22, 26 specimens from bronchoalveolar lavages) the microbiological yield was 73%, Pneumocystis carinii being the commonest infective agent (n = 14). P carinii pneumonia was found only in children with deficient antigen induced lymphocyte proliferative responses who had not been treated with long term prophylactic co-trimoxazole. In contrast, in 13 children with chronic interstitial pneumonitis that was consistent with a diagnosis of pulmonary lymphoid hyperplasia who underwent bronchoalveolar lavage on 17 occasions, there were two isolates of cytomegalovirus and one of adenovirus, but P carinii was not found. Ten of the 13 children had normal antigen induced lymphocyte proliferative responses. Useful cytological data were also gleaned from bronchoalveolar lavage specimens. Lymphocytosis was significantly higher in pulmonary lymphoid hyperplasia (36(SD 11)%) than in P carinii pneumonia (24(19)%) whereas the percentage of polymorphonuclear neutrophils was significantly lower (3(2)% compared with 12(13)%). Flexible bronchoscopy with bronchoalveolar lavage is safe even in young infants and should reduce the necessity for open lung biopsy in the management of HIV infected children with interstitial pneumonitis.
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PMID:Bronchoalveolar lavage in HIV infected patients with interstitial pneumonitis. 281 43


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