British journal of anaesthesia
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An artificial patient capable of spontaneous and artificial ventilation has been used for bench testing of the Ohmeda CPU-1. This ventilator has an extensive capacity for interaction with the spontaneous breathing of the patient, and provides a wide variety of operating modes. These include spontaneous breathing with or without continuous positive pressure, volume-cycled and pressure-cycled artificial ventilation, with or without positive end-expiratory pressure or synchronization. ⋯ The synchronization permits adaptation of the ventilator to spontaneous respiration according to a wide range of harmonics. In any mode, artificial ventilation is initiated if spontaneous respiration is inadequate. The mandatory minute volume mode is based on a complicated program of a cautious nature which reacts instantly to inadequate spontaneous breathing, but is slow to discontinue artificial ventilation.
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Randomized Controlled Trial Clinical Trial
Effect of heat conservation during and after major abdominal surgery on muscle protein breakdown in elderly patients.
Changes in mean body temperature and muscle protein metabolism were studied in elderly patients undergoing large bowel surgery. Two groups were studied: in one, efforts were made to maintain the patients normothermic during and after surgery by warming the fresh gases, the i.v. fluids, by placing warmed cotton padding around the exposed parts of the body and by covering the patients with a metallized plastic sheet in the recovery period. ⋯ The excretion of the amino acid 3-methylhistidine (3-MeH), an indicator of muscle protein breakdown, and urea nitrogen loss were measured in the urine collected the day before, and on the 2nd and 4th postoperative days. Prevention of heat loss during and after surgery caused a significant decrease in muscle protein degradation and nitrogen loss.
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Male Fischer 344 rats were exposed to halothane, enflurane or isoflurane vapour 20 p.p.m., or air, for up to 30 weeks. None of the anaesthetic agents led to hepatocellular necrosis. ⋯ Urinary fluoride excretion was increased during exposure to either enflurane or isoflurane. Using this increase as an index of anaesthetic biotransformation, we found that the extent of biotransformation of isoflurane was only slightly lower than that of enflurane.
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Conventional anaesthetic breathing systems are not designed to control end-tidal gas concentrations, nor can they be used to measure accurately the uptake of oxygen or of anaesthetic agent. We built and tested a leak-tight closed-loop anaesthetic breathing system with low solubility to volatile anaesthetic agents and with efficient gas mixing. The system included a water-sealed spirometer, a small carbon dioxide absorber, a coaxial tube to the patient, a circulating pump and feedback controllers for system volume and anaesthetic concentration. ⋯ Stability was maintained with +/- 50% changes in alveolar ventilation and cardiac output. During subsequent investigations in an animal model, arterial, mixed venous and cerebral venous blood halothane concentrations were measured to show that the feedback-controlled halothane induction was optimized. We conclude that feedback control appears to be clinically applicable for adjusting the end-tidal halothane concentration and system volume to provide a rapid and optimized induction of anaesthesia.
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Conventional anaesthetic techniques do not allow for the automatic control of end-tidal halothane concentration and, therefore, brain concentration cannot be predicted. In this study, eight dogs were ventilated with halothane in oxygen using a new closed-loop anaesthetic breathing system which provided a constant end-tidal concentration. During the first 60 min the end-tidal concentration was maintained at 0.87 vol% (1 MAC). ⋯ Measured uptake differed from theoretically calculated uptake by 18.3-57.6%, depending on the model used. Measured arterial and cerebral venous concentrations differed from theoretically calculated values by 7% and 17.5%, respectively. It was shown that the required end-tidal concentrations can be obtained rapidly and accurately, and that brain tissue concentrations can be predicted within certain limits.