Acta anaesthesiologica Scandinavica
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Exact placement is an essential prerequisite for long-term use of a central venous catheter. Reported data show an extremely wide range of catheteral misplacements: from less than 1% to more than 60%. Some approaches appear to be less advantageous than others, but the highest rates of misplacement occur in the cubital, external jugular and saphenous veins. ⋯ The total frequency for pure loop formation was 2.9%. The authors discuss numerous reported data on catheter malpositioning, according to the specific techniques used, and compare them with thier own results. The relatively low incidence in the present series is possibly due to the high proportion of cases where the supraclavicular subclavian approach was used, the omission of the sphrenous/femoral and cubital techniques, and to pre-determining the length of the inserted catheteral segments.
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Acta Anaesthesiol Scand · Jan 1975
Complications to tracheostomy and long-term intubation: a follow-up study.
Hospital records of 79 patients treated with tracheostomy or long-term intubation from 1969 to 1971 were reviewed, and the 43 surviving patients were examined by laryngoscopy, x-ray and spirometry for complications subsequent to these treatments. Early complications included one tube occlusion and one case of postextubation stridor in each group, one dislocated tube, one bilateral pneumothorax, and one case of fatal innominate arterial hemorrhage in the tracheostomy group, and two cases of atelectasis in the long-term intubation group. ⋯ Late complications in surviving patients were prolonged hoarseness in six patients treated with prolonged intubation, two of whom had also had tracheostomy. Radiologically verified tracheal stenosis (40-60%), four at the stoma level and one at the cuff level, all occurred in the tracheostomy group.
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Acta Anaesthesiol Scand · Jan 1975
Case ReportsBrain damage following collapse of a polyvinyl tube: elasticity and permeability of the cuff.
A 13-year-old boy undergoing tympanoplasty lasting 3 1/2 hours developed serious airway obstruction at the end of surgery leading to permanent brain damage. It appeared that the no. 7 Portex "blue line" endotracheal tube had collapsed under the cuff. This was concluded because deflation of the cuff had promptly relieved the obstruction of the airway. ⋯ During anaesthesia with 66% nitrous oxide, this gas together with carbon dioxide were found to diffuse into the cuff at steady rates of 3.69 vol % and 0.36 vol % per hour, respectively. Corresponding increases in intracuff volumes were found. It is advised that disposable tubes should be carefully inspected before use and that endotracheal cuffs should be deflated periodically during anaesthesia to avoid excessive rise in cuff pressure.
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Acta Anaesthesiol Scand · Jan 1975
Anesthesia for cesarean section II: effects of the induction-delivery interval on the respiratory adaptation of the newborn in elective cesarean section.
Ten healthy mothers and their infants were studied in connection with elective cesarean section. Anesthesia was induced with 250-300 mg hexobarbitone followed by 100 mg succinylcholine for endotracheal intubation. The surgeon started the operation when the eyelid reflex disappeared, and delivered the baby as quickly as possible. ⋯ At the interviews, two mothers complained of pain during skin incision, and two of nightmares. Anesthesia with barbiturate for cesarean section with the I-D intervals studied in both groups allowed good respiratory adaptation in the infants. There is, neverless, the need for an adequate period of time between induction and the start of the operation in order to minimize the risk for maternal awareness.
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Acta Anaesthesiol Scand · Jan 1975
The influence of arterial carbon dioxide tension on the cerebrovascular response to arterial hypoxia and to haemodilution.
Cerebral blood flow (CBF) measurements and blood gas analyses were performed on anaesthetized and artifically ventilated dogs during arterial hypoxia or haemodilution in different ranges of arterial carbon dioxide tension. Arterial hypoxia as well as haemodilution produced a flow increase in all ranges of ventilation. ⋯ On the assumption that the cerebrovenous oxygen tension reflects the oxygen tension of the brain tissue, it is suggested that the arterial carbon dioxide tension influences the ability of the brain tissue to maintain the aerobic metabolism during reduced tissue oxygen tension. This means that tissue hypoxia, in the sense of utilisation of anaerobic metabolism, occurs at a tissue oxygen tension which is lower the lower the arterial carbon dioxide tension is.