Journal of anesthesia
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Journal of anesthesia · Apr 1991
Accidental extubations during respiratory management in a children's hospital.
An investigation was conducted on the frequency of accidental extubations at Shizuoka Children's Hospital during the past 12 years. The study was performed on 150 randomly selected patients who received respiratory support for more than 24 hr. Fifteen accidental extubations occurred in 9 patients. ⋯ It became clear that more immature babies were more likely to suffer accidental extubation, perhaps reflecting the fact that most of the immature babies in the NICU were intubated orally, and that a larger proportion of them required a longer period of respiratory support. Therefore, early weaning from respiratory support is recommended if it is possible. In conclusion, increased surveillance and more secure methods of taping of endotracheal tubes are crucial for preventing life-threatening accidental extubations during respiratory support.
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Laryngeal mask airway (LMA) insertion was tried in 120 pediatric cases, from 2 months to 12 years of age. Initial indications for LMA were the same as for a face mask, except for two additional conditions; anticipation of difficulty with intubation and difficulty in management by a face mask. Size 2 LMA was used in the vast majority of cases. ⋯ LMA-aided tracheal intubation can be extremely useful in obtaining endotracheal airways. Non-blind techniques can be used with LMA to increase safety. LMA is a very useful addition to pediatric anesthesia practice.
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Journal of anesthesia · Apr 1991
Respiration by tracheal insufflation of oxygen (TRIO) at high flow rates in apneic dogs.
Tracheal insufflation of oxygen (TRIO) is a technique in which oxygen is introduced into the trachea at a constant flow rate via a catheter advanced to the level of the carina. We studied the effects of flow rates (0.5, 1.0, 1.5 and 2.0 l.kg(-1).min(-1)) on arterial blood gases during TRIO in 6 apneic dogs. The constant flow was administered through the tip of a catheter (I. ⋯ TRIO, at a flow rate of 3 l.kg(-1).min(-1), was able to maintain normocarbia over 4 hr. The mean Pa(O)(2) and Pa(CO)(2) at 4.0 hr were 465 +/- 77 and 41 +/- 4 mmHg. Although the mechanism of pulmonary gas exchange during TRIO is unclear, our study is the first to document that normocarbia can be maintained by high-flow TRIO in apneic dots.
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Journal of anesthesia · Oct 1990
Effects of intravenous or endotracheal lidocaine on circulatory changes during recovery from general anesthesia.
Intravenous lidocaine (1.5 mg.kg(-1)) was not effective in attenuating the circulatory changes and the cough reflex induced by airway stimulation during recovery from general anesthesia, whereas endotracheal 4% lidocaine (3 ml) was effective. The arterial concentration of the intravenously administered-lidocaine peaked at a level of 9.52 +/- 0.81 microg.ml(-1) 0.5 min later. The arterial concentration of the endotracheally administered-lidocaine peaked at 1.44 +/- 0.13 microg.ml(-1) 15 min later. These findings indicate that the endotracheal administration of lidocaine may be superior to the intravenous administration for attenuating the circulatory changes and the cough reflex during recovery from general anesthesia, and that the arterial concentration of lidocaine did not correlate with the clinical efficacy for this purpose.
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Journal of anesthesia · Oct 1990
Characteristic changes between core and peripheral surface temperature related with postanesthetic shivering following surgical operations.
The relationship between changes in the core and the surface temperature and postanesthetic shivering was studied in 100 patients who underwent general anesthesia. Patients were classified into four groups by the patterns of change in the core and peripheral surface temperature. Type II and type IV groups of patients showed a decrease in surface temperature during the major operation such as gastrectomy and radical mastectomy. ⋯ However, in patients in type I and III, the rate of shivering was low. Evaluation of the difference between core and peripheral surface temperature may be important to manage body temperature at a steady level during the operation. The monitoring of body temperature difference between core and peripheral surface during the operation may be useful for predicting to occurrence of postanesthetic shivering.