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Query: UMLS:C0278134 (anesthesia)
 110,339 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective analysis of 50 patients who had been observed to aspirate gastric contents was performed to define better the course of patients with this syndrome. The patients invariably had a disturbance of consciousness, most commonly due to sedative drug overdose or general anesthesia. The onset of clinical signs occurred prompty after aspiration and tended to be similar in all patients, irrespective of their subsequent course or outcome. These findings usually included fever, tachypnea, diffuse rales, and serious hypoxemia. Cough, cyanosis, wheezing, and apnea were each seen in approximately one third of the cases. Apena, shock, and early severe hypoxemia were particularly ominous events. Initial roentgenograms revealed diffuse or localized alveolar infiltrates, which progressed during the next 24 to 36 hours. Subsequent clinical courses followed 3 patterns: 12 per cent of the patients died shortly after aspiration; 62 per cent had rapid clinical and radiologic improvement, with clearing, on average, within 4.5 days; 26 per cent demonstrated rapid improvement, but then had clinical and radiographic progression associated with recovery of bacterial pathogens from the sputum and a fatal outcome in more than 60 per cent. Treatment from the outset by adrenocortical steroids or antimicrobial agents had no demonstrable effect on the outcome. The clinical features of aspiration of gastric contents are characteristic and distinguish it from other forms of aspiration-related lung disease.
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PMID:Pulmonary aspiration of gastric contents. 100 48

Sixty-seven aspirin-sensitive asthmatic patients underwent a total of 89 operative procedures. Wheezing with induction, intraoperative tachycardia and arrhythmias, and postoperative wheezing were the major problems in their anesthetic course. Wheezing was encountered despite various induction technics. Preoperative steroids, aminophylline, and ephedrine appeared necessary for surgical preparation, but the presence of aminophylline and ephedrine predisposed to tachycardia under anesthesia. The appearance of mild preoperative wheezing allows the prediction of postoperative wheezing in a significant number of patients.
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PMID:Anesthetic problems with aspirin-intolerant patients. 116 29

During anesthesia, wheezing and difficult breathing are dangerous, requiring prompt therapy. The pressurized isoproterenol cartridge described in this report may be interposed conveniently in the anesthesia breathing system, is inexpensive, and provides accurate dosage. This device proved effective in treating bronchospasm and decreasing wheezing and secretions in 11 out of 12 cases. The mean (+/- SEM) peak airway pressure was 43 (+/- 2) torr before and 31 (+/- 2) torr after treatment; mean Paco2 was lowered from 60 (+/- 6) to 47 (+/- 4) torr; mean pH increased from 7.24 (+/- 0.03) to 7.33 (+/- 0.03), and mean percent increase in Pao2 was 32 (+/- 13.4). No cardiac arrhythmias, tachycardia, or rise in blood pressure were observed.
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PMID:Treatment of bronchospasm during anesthesia. 123 18

Isoflurane is generally considered to prevent increase in bronchomotor tone. We report a case of bronchospasm associated with exposure to isoflurane. A 11-year-old girl was scheduled for tonsillectomy because of repeated fever. Anesthesia was induced with nitrous oxide, oxygen and sevoflurane. Sevoflurane was switched to isoflurane and increased gradually to 3%. Shortly after inhalation of isoflurane, eruption at chest appeared and auscultation of the chest revealed dry rale. Aminophylline and hydrocortisone were injected and isoflurane was discontinued. Ventilation with sevoflurane was started, but there was no improvement. Intramuscular epinephrine was given and sevoflurane was discontinued. After this, the wheezing improved. Four days later she underwent tonsillectomy under sevoflurane anesthesia uneventfully.
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PMID:[A case of bronchospasm during induction of isoflurane anesthesia]. 146 Jul 58

A case of severe asthmatic attack treated by isoflurane inhalational anesthesia and bronchial lavage is reported. A 24-year-old woman was admitted to our hospital with severe asthmatic attack. Although she was treated by intravenous administration of aminophylline and corticosteroids, pulmonary function and consciousness deteriorated. Therefore, she was intubated nasally and mechanically ventilated by IPPV with administration of aminophylline, corticosteroids and epinephrine. Despite this treatment, she remained in status asthmaticus with high airway pressure and barotrauma causing pneumomediastinum and subcutaneous emphysema. On the 3rd hospital day, a system was arranged so that isoflurane could be given in an air and oxygen mixture, and administration was started with a concentration of isoflurane of 1.5%. In addition, bronchial lavage via bronchoscopy was performed in order to clear any mucous plugs. After 24 hours, there was marked improvement of wheezing, airway pressure and arterial blood gas level. Eventually, she was weaned from the ventilator on the 6th hospital day without significant side effects. The use of halothane inhalational anesthetic treatment for status asthmaticus is widely known, but it has serious side effects such as arrhythmia and liver injury. Isoflurane may be the inhalational anesthetic agent of choice in the treatment of status asthmaticus.
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PMID:[A case of intractable status asthmaticus treated by isoflurane inhalational anesthesia and bronchial lavage]. 146 92

Twenty-seven main bronchial resections (19 left, 8 right) were performed without pulmonary resection between 1975 and 1991. The patients were 17 men and 9 women with an average age of 35 years (range, 20 to 65 years). Tumors comprised 55% of the lesions, including 9 carcinoid tumors (33%), 2 mucoepidermoid tumors, 2 fibrous histiocytomas, 1 hemangiopericytoma, and 1 large cell carcinoma. Scarring and stenosis secondary to multiple causes occurred in 10 patients (37%). Two patients had miscellaneous lesions. Presenting symptoms included dyspnea (52%), wheezing or stridor (44%), cough (41%), hemoptysis (37%), and pneumonia (18%). Preoperative chest roentgenogram was abnormal in 60% of patients, whereas tomograms delineated the lesion in 94%. All patients had bronchoscopy for lesion evaluation. Anesthesia was accomplished through a long single-lumen endotracheal tube in 19 cases and a double-lumen tube in 8 cases. Mobilization and exposure techniques to create a tension-free anastomosis were critical for left main bronchial resections and included pretracheal mobilization (100%), neck flexion (100%), tracheal and main bronchial retraction (85%), aortic and pulmonary artery retraction (44%), and intrapericardial hilar release (33%). All resections were for cure; there was no operative mortality. Morbidity in 4 patients (15%) included an anastomotic stenosis (successfully reresected), prolonged air leak and pneumonia, transient recurrent nerve palsy, and atelectasis. Median 5-year follow-up revealed 92% of patients alive, with only one of two late deaths being disease-related. Main bronchial resection is an ideal technique for selected benign and malignant lesions, allowing complete pulmonary parenchymal preservation.
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PMID:Main bronchial sleeve resection with pulmonary conservation. 175 80

Incidence of foreign body aspiration in tracheobronchial tree is rare, however the foreign body aspiration can lead to severe illness and even death if not diagnosed and treated promptly. We retrospectively analyzed forty five patients who underwent ventilation bronchoscope under general anesthesia for suspected aspirated foreign bodies in our hospital. In thirty eight patients, foreign body was confirmed in tracheobronchial tree, while in seven patients foreign body was not confirmed with bronchoscope. The thirty eight patients ranged in age from 10 months to 73 years; the peak incidence of foreign body aspiration occurred in children under 3 years of age. Twenty five of thirty eight patients were male. Food or food derivatives were the causative agents in 68% of the patients, with 65% due to a portion of peanut. The foreign body was located in the right and left bronchus with almost equal frequency. The main symptoms were coughing (72%), wheezing (53%), and dyspnea (25%). The radiographic abnormality was seen in eighteen of thirty eight patients. A radio-opaque material was seen in 18%. Children at age 6 years of younger (90%) had been witnessed to choke on identifiable foreign body, but only 40% were diagnosed within 24 hours. Twelve of these children were treated unnecessarily for asthma, pneumonia, or so on. We conclude that it is most important to take history carefully considering the possibility of foreign body aspiration in the patients with coughing, wheezing, or dyspnea.
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PMID:[Statistical analysis of tracheobronchial foreign bodies]. 194 19

The pathophysiologic effects of histamine in anaphylaxis have been shown to be mediated through H1 and H2 receptors, individually and in combination. H1 receptors mediate coronary artery vasoconstriction, wheezing, cutaneous vascular permeability, and possibly an increase in pulse rate. H2 receptors stimulate ventricular and atrial inotropy, arterial chronotropy, coronary vasodilation, and rises in basophil cyclic adenosine 3':5' monophosphate (cyclic AMP). (Neither receptor mediates increases in cyclic AMP in mast cells.) H1 and H2 receptors in combination seem to be most potent in mediating flush, headache, increases in pulse pressure, and decreases in diastolic blood pressure. Clinical trials have been conducted to determine the efficacy of H1 and H2 antagonists in preventing anaphylactic reactions to plasma expanders, anesthesia-inducing agents, morphine, and radiocontrast material. Concurrently, retrospective observations of the prevention of anaphylactic reactions to chymopapain have been recorded. Despite some conflicting and inconclusive data, the sum of these studies indicates that pretreatment with a combination of H1 and H2 antagonists is more effective than H1 antagonists alone in preventing reactions to these agents. These results, when added to the available knowledge of the physiology of histamine release, support the preferential use of H1/H2 antagonist combinations in the prevention and treatment of anaphylaxis and anaphylactoid reactions.
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PMID:The use of antihistamines in the prevention and treatment of anaphylaxis and anaphylactoid reactions. 197 85

We have used flexible fibreoptic bronchoscopy using sedation and local anaesthesia in 50 children aged 2-19 years (median 10) using an Olympus BFP20 instrument. Indications were opportunistic pneumonias (n = 11), persistent atelectasis (n = 11), recurrent pneumonia (n = 7), miscellaneous lower airway disease (n = 7), recurrent wheezing (n = 3), haemoptysis (3), to diagnose infection or rejection of heart-lung transplants (n = 3), stridor (n = 2), suspected airway compression (n = 1), evaluation of tracheostomy (n = 1), and suspected foreign body (n = 1). In 43 cases (86%) the diagnosis was related to the primary indication. In five (10%) unrelated abnormalities were found, and five (10%) were normal. In 13 (26%) treatment was altered as a result of flexible fibreoptic bronchoscopy. Complications were transient respiratory arrest (n = 2), hypoxia (n = 2), pneumonia (n = 2), and laryngospasm (n = 1). All complications were followed by complete recovery. Our results suggest that flexible fibreoptic bronchoscopy is safe. Advantages over rigid bronchoscopy include greater visual range, fewer complications, and the avoidance of a general anaesthetic. Though invasive it can yield important diagnostic and therapeutic information.
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PMID:Fibreoptic bronchoscopy without general anaesthetic. 203 4

To clarify the prophylactic effect of epidural anesthesia with buprenorphine on postoperative pulmonary complications, the incidence of pulmonary complications after chest surgery was evaluated in 2 groups: the group that underwent epidural anesthesia, namely the test group, and the control group. Pulmonary complications were classified as follows: mild complications, sustained wheezing and/or small atelectasis-like shadows seen on chest x-rays. These improved by conventional methods except for bronchial toilet. Moderate complications included pneumonia and/or respiratory failure and/or atelectasis which needed bronchial toilet. There were 56 cases (58%) with no pulmonary complications in the control group and 89 cases (77%) in the test group. The number of patients with pulmonary complications were 40 (42%) in the control group and 27 (23%) in the test group, respectively (p less than 0.01). Those with mild or moderate complications were 25 (26%), 15 (16%) in the control group and 21 (18%), 6 (5%) in the test group, respectively. There was significant difference between no complication group and moderate complication group (p less than 0.01). These results show that epidural anesthesia is useful in preventing pulmonary complications after chest surgery.
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PMID:[Epidural anesthesia with buprenorphine for chest surgery and its prophylactic effects of postoperative pulmonary complications]. 229 47


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