Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Hypoxic pulmonary vasoconstriction (HPV) is a fundamental physiological process whereby ventilation/perfusion matching is optimized through the constriction of the pulmonary circulation supplying poorly ventilated lung units. In their 1981 paper in the Journal, Noble, Kay, and Fisher used a series of animal experiments to show that alveolar carbon dioxide (CO2) plays a critical role in the regulation of hypoxic pulmonary vasoconstriction. At physiological concentrations, CO2 potentiates the HPV response, and the absence of alveolar CO2 blunts HPV. The enhancement of HPV by CO2 resulted in reduced perfusion of specific hypoxic lung regions, thereby improving systemic oxygenation in lung-ventilated dogs.
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Comparative Study
The diagnostic accuracy of estimated continuous cardiac output compared with transthoracic echocardiography.
Estimated continuous cardiac output (esCCO) is a new and noninvasive cardiac output (CO) monitoring device using pulse wave transit time. The aim of this study was to assess rapid changes in CO using esCCO (ΔCOesCCO) without invasive calibration and to compare the results with those using transthoracic Doppler echocardiography (ΔCOTTE). ⋯ Estimated continuous cardiac output without external calibration seems unable to assess rapid changes in CO following cardiac surgery and was not interchangeable with transthoracic Doppler echocardiography.
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Observational Study
Elective use of an uncuffed small-bore cricothyrotomy tube with balloon occlusion of the subglottic airway.
To conduct a qualitative observational study on positive pressure ventilation through a percutaneous uncuffed small-bore cricothyrotomy tube with balloon occlusion of the subglottic airway to minimize supraglottic leak. ⋯ This technique provides effective intraoperative ventilation and easy endoscopic access, and it countermeasures against the likely complication of postoperative laryngeal edema. Moreover, there is no need for conventional tracheostomy or prolonged intubation. This approach establishes a curative and less invasive pharyngeal cancer therapy. Certain adverse outcomes can be avoided, including impaired speech and swallowing, possible delayed closure of the stoma, or a compromised cosmetic outcome.
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Historical Article
From the Journal archives: Epidural anesthesia in young children: What have we learned in the past 60 years?
Francis G. Ruston MD CITATION: Ruston FG. Epidural anaesthesia in infants and children. Can Anaesth Soc J 1954: 1: 37-44. ⋯ Epidural anesthesia in infants and young children is effective for a variety of procedures below the diaphragm, even in moribund patients.