To determine whether single breath end-tidal carbon dioxide (PE'CO2) measurements accurately estimate arterial PCO2 (PaCO2) in infants and children, 68 healthy infants and children, ASA physical status I or II scheduled for peripheral and lower abdominal surgery requiring endotracheal intubation were studied. A 3 ml single breath sample was obtained with a 23-gauge needle which was inserted through the wall of the endotracheal tube below the connector. The mean +/- SD PE'CO2 33.6 +/- 6.9 mmHg did not differ significantly from the corresponding mean +/- SD PaCO2 33.6 +/- 5.6 mmHg. The coefficient of determination, r2, was 0.97. The authors conclude that single breath PE'CO2 measurements from the proximal end of the endotracheal tube accurately estimate the PaCO2 in infants and children.

Adolescent↗

PubMed1989

Passive and active inspired gas humidification in infants and children.

The hypothesis that both active and passive airway humidification prevents hypothermia in infants and children, but that neither decreases the duration of postoperative recovery was tested. Twenty-seven ASA physical status 1 or 2 patients were studied who weighed between 5 and 30 kg, underwent superficial operations, were anesthetized with halothane and 70% N2O, and whose lungs were ventilated via a Rees modification of an Ayre's t-piece. The children were randomly assigned to receive active airway humidification and warming using an MR450 Servo airway heater and humidifier set at 37 degrees C (n = 10), passive airway humidification using the Humid-Vent 1 heat and moisture exchanger placed between the Ayre's t-piece and the endotracheal tube (n = 8), or no airway humidification and heating (control, n = 9). Distal tracheal and tympanic membrane temperatures and airway humidity were recorded during the first 90 min of surgery. Rectal temperature was measured during the postanesthetic recovery period. Relative humidity of inspired respiratory gases was approximately 30% in the control group and approximately 90% in the group given active airway humidification. Initial inspired humidity in the passive humidification group (50%) increased to approximately 80%, a level not significantly different from that in the active group after 80 min of anesthesia. Central body temperature increased 0.25 degrees C during active active airway humidification and heating, whereas temperature decreased 0.25 degrees C during passive humidification and 0.75 degrees C without airway humidification. Distal tracheal temperature was significantly higher in the groups given passive and active humidification than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia Recovery Period↗

PubMed1989

Passive or active inspired gas humidification increases thermal steady-state temperatures in anesthetized infants.

We tested the hypothesis that active and passive airway humidification minimize hypothermia in infants, but that maintaining normothermia does not decrease the duration of postoperative recovery. A circle system was used to ventilate the lungs of anesthetized, intubated infants who were randomly assigned to active airway humidification and warming with use of an MR450 Servo airway heater and humidifier set at 37 degrees C (n = 10), passive airway humidification with use of the Humid-Vent Mini heat and moisture exchanger placed between the Y-piece of the circle and the endotracheal tube (n = 10), or no airway humidification and heating (control, n = 10). Anesthesia was induced with thiopental and maintained with isoflurane and nitrous oxide in oxygen. The relative humidity of inspired respiratory gases was approximately 35% in the control group and approximately 90% in the group undergoing active airway humidification. Initial inspired humidity in the passive humidification group (45%) increased to approximately 80% after 1 h of anesthesia. Humidity differed significantly across groups at all times (P less than or equal to 0.05). Steady-state rectal temperatures (100-120 min after induction) were 36.2 +/- 0.7 degrees C in patients given active humidification and heating, 35.7 +/- 0.9 degrees C in the passively humidified group, and 35.2 +/- 0.4 degrees C in the control group (P less than or equal to 0.05 between each group). Recovery from general anesthesia was rapid in all patients and did not correlate with central temperature changes or type of humidification (P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗

PubMed1989

Intraoperative temperature monitoring sites in infants and children and the effect of inspired gas warming on esophageal temperature.

This study tested the hypotheses that 1) temperatures of "central" sites are similar in infants and children undergoing noncardiac surgery and 2) airway heating and humidification increases distal esophageal temperature. Twenty children were randomly assigned to receive 1) active airway humidification using an airway heater and humidifier set at 37 degrees C (N = 8), 2) passive airway humidification using a heat and moisture exchanger (N = 6), or 3) no airway humidification and/or heating (control, N = 6). There were no statistically significant differences between tympanic membrane, esophageal, rectal, and axillary temperatures. The temperatures of the peripheral skin surface (forearm and fingertip) were significantly lower than tympanic membrane temperature and significantly different from each other. Although esophageal and tympanic membrane temperatures in the entire group were similar, esophageal temperatures in patients receiving active and passive airway humidification were about 0.35 degrees C above tympanic temperatures after induction of anesthesia. In contrast, esophageal temperatures in patients without airway humidification were 0.25 degrees C below tympanic temperatures after induction of anesthesia. Esophageal-tympanic membrane temperature differences in the patients given active and passive humidification differed significantly from the corresponding sum in the control group at all times, but not from each other.

Anesthesia, Inhalation↗

PubMed1986

Obstruction of fresh gas flow in an Ayre's T-piece.

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Anesthesiology↗

PubMed1986

Pseudorheumatoid deformity of the feet associated with parkinsonism.

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Female↗

PubMed1985

[Osteoporosis].

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Adult↗

PubMed1984

[Esophageal ulcer caused by doxycycline].

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Adult↗

PubMed1983

Reactive arthritis with eosinophilic synovial infiltration.

A 17-year-old Cambodian-born female was recently evaluated for subacute seronegative arthritis involving both ankles and the right midfoot. Suboptimal response to a nonsteroidal anti-inflammatory drug prompted open synovial biopsy, which showed intensive eosinophilic infiltration of the synovial structures. Slight peripheral eosinophilia had been found before her admission to hospital, and Ankylostoma duodenale was isolated. Antiparasitic treatment offered little more relief. She was also found out to be a carrier of the histocompatibility antigen HLA B27, and it may be that despite unusual histological findings she had a B27-related reactive type of arthropathy. The relation to the parasitic infestation remains speculative.

Adolescent↗