Anesthesia and analgesia
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Anesthesia and analgesia · May 2004
Intratracheal application of recombinant surfactant protein-C surfactant to rabbits attenuates acute lung injury induced by intratracheal acidified infant formula.
Our aim in the current study was to determine whether recombinant surfactant protein-C (rSP-C) surfactant improves acute lung injury (ALI) induced by intratracheal acidified milk products. Twenty-eight rabbits were randomly divided into four groups. ALI was induced with intratracheal acidified infant formula (0.8 mL/kg, pH 1.8) in 3 groups. The control group received intratracheal acidified saline. Therapy groups received 1 of 2 doses of intratracheal rSP-C surfactant (0.5 or 2 SP-C mg/kg) 30 min after the acidified infant formula. The lungs were ventilated with 100% oxygen for 4 h after induction of ALI. Acidified infant formula dramatically reduced oxygenation and lung compliance, and increased resistance. Both doses of rSP-C improved the variables [mean PaO(2) (mm Hg) and compliance (mL/cm H(2)O) at 4 h: 61 and 0.4 for infant formula, 162 and 1.0 for small-dose rSP-C, and 152 and 1.2 for large-dose rSP-C, respectively; P < 0.05]. Pulmonary leukosequestration and edema, and severe morphological changes were attenuated by rSP-C treatment (ALI score: 14, 7, 7 in infant formula, small-dose rSP-C, and large-dose rSP-C; P < 0.05). The efficacy was similar for the two doses of rSP-C. These findings suggest that intratracheal administration of rSP-C ameliorates ALI induced by aspiration of acidified milk products. ⋯ Small or large doses of recombinant surfactant protein-C surfactant given 30 min after intratracheal acidified infant formula attenuated physiological, biochemical, and morphological lung damage.
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Anesthesia and analgesia · May 2004
Spinal anesthesia with bupivacaine decreases cerebral blood flow in former preterm infants.
Spinal anesthesia is commonly used in former preterm infants (FPI). In these patients, hypotension induced by spinal anesthesia may impair cerebral blood flow. We measured cerebral blood flow velocity (CBFV) by transcranial Doppler ultrasound to assess the effect of hypotension induced by spinal anesthesia on cerebral hemodynamics. Twelve FPI scheduled for inguinal hernia repair were operated under spinal anesthesia using 1 mg/kg isobaric 0.5% bupivacaine. Systolic, diastolic, and mean middle cerebral artery CBFV were measured at 5 min before and 5 min and 10 min after spinal anesthesia using a transcranial pulsed Doppler ultrasonography. Arterial blood pressure and heart rate were recorded simultaneously. Cerebral arteries resistance index (RI) was calculated as RI = (peak systolic CBFV - end-diastolic CBFV)/peak systolic CBFV. Diastolic CBFV decreased significantly from 30.0 +/- 11.1 cm/s to 20.1 +/- 8.4 cm/s at 5 min and to 20.1 +/- 7.0 cm/s at 10 min. RI increased significantly from 0.7 +/- 0.1 to 0.8 +/- 0.1 at 5 min and 10 min. Systolic, diastolic, and mean arterial blood pressures decreased significantly at the same time intervals. We suggest that in FPI, spinal anesthesia induces a decrease in cerebral blood flow related to changes in arterial blood pressure. Whether these changes have deleterious consequences remains to be determined. ⋯ In former preterm infants having spinal anesthesia with bupivacaine, a decrease in cerebral blood flow velocity is displayed by middle cerebral artery transcranial Doppler examination.
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Anesthesia and analgesia · May 2004
Case ReportsTransient vascular insufficiency after axillary brachial plexus block in a child.
Axillary block is used in children for procedures on the hand and forearm. We report on a child with an amputation of the thumb in whom an axillary block was given, after which the limb became pale and pulseless. The pulses returned spontaneously in 15 min. The awareness of this possibility and chances of spontaneous recovery should be considered. ⋯ Transient vascular insufficiency of the upper limb may happen as a rare complication after axillary block. Knowledge of this complication can help the anesthesiologist in the management of this problem.
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Anesthesia and analgesia · May 2004
Case ReportsTracheal ring fracture during a PercuTwist tracheostomy procedure.
Because of difficult weaning from mechanical ventilation, a 59-yr-old man admitted for emergency cardiac surgery underwent a bedside PercuTwist tracheostomy on day 14 of his intensive care unit stay. We observed a double fracture of the second tracheal ring during the initial dilation process with the PercuTwist dilator, associated with distal migration of a cartilage fragment, which was avulsed from the anterior portion of the second cartilaginous ring. ⋯ Like other antegrade single-step techniques, the PercuTwist tracheostomy presents the risk of anterior tracheal wall damage during the initial stage of the dilation process. Antegrade forces applied to the trachea should be minimized by sufficiently deep skin incision and both slow and smooth initial rotation of the dilator.