The purpose of this review is to describe the pathogenesis of pulmonary oedema associated with upper airway obstruction, summarize what is known of its clinical presentation, and reflect upon its implications for the clinical management of airway obstruction. The pathogenesis of pulmonary oedema associated with upper airway obstruction is multifactorial. However, as the phrase "negative pressure pulmonary oedema" suggests, markedly negative intrapleural pressure is the dominant pathophysiological mechanism involved in the genesis of pulmonary oedema associated with upper airway obstruction. The frequency of the event is impossible to ascertain from the literature but paediatric cases requiring airway intervention for croup or epiglottitis and adults requiring airway intervention for emergence laryngospasm or upper airway tumours account for over 50 per cent of the documented cases in each age group, respectively. Individuals at risk should be observed closely while they remain at risk. The majority of cases present within minutes either of the development of acute severe upper airway obstruction or of relief of the obstruction. Resolution is typically rapid, over a period of a few hours. Rarely is anything more required for management than the maintenance of a patent airway, supplemental oxygen, and, in approximately 50 per cent of cases, mechanical ventilation and positive end-expiratory pressure.

Adult↗

PubMed1990

Beverly Charles Leech (1898-1960).

Explore the source record for details and available documents.

Anesthesiology↗

PubMed1990

The evolution of anaesthesia as a specialty in Canada.

Since 1847 anaesthesia in Canada has evolved through six phases. In the first (1847-1898), it was a craft without an academic and professional base. The second (1899-1919) was marked by the first academic appointments and by Canadians' wartime experiences of anaesthesia. The third phase (1920-1929) evidenced the professional satisfaction of anaesthesia and included the founding of the Canadian Society of Anaesthetists. In the fourth phase (1930-1943) the growth of the Royal College of Physicians and Surgeons of Canada, the introduction of certification and the founding of the definitive professional society--the Canadian Anaesthetists' Society--fostered the evolution of what was now becoming a recognizable specialty. The fifth phase (1944-1971) was one of resolution of problems affecting the status of anaesthesia: the first autonomous department of anaesthesia in a Canadian university was founded (at McGill in 1945), the Royal College Fellowship was approved for anaesthesia (in 1951), the Canadian Anaesthetists' Society Journal was launched (in 1954) and a single standard for certification of specialists was finally established (in 1971). In the sixth (1972-1989), the main elements were the assumption of responsibility for residency training by the universities and by the renaming of the journal as the Canadian Journal of Anaesthesia. Through these years of increasing professionalism, it has, however, been the accomplishments of individual Canadian physicians, facing many challenges, that have made the specialty in Canada recognizably Canadian.

Anesthesiology↗

PubMed1989

John Snow and research.

John Snow's leadership in epidemiology as well as anaesthesia resulted from his research as much as his clinical practice. In anaesthesia, Snow's research concerned the regulation of concentrations of volatile agents and the development of efficient inhalers; the uptake and elimination of volatile agents; stages of anaesthesia; carbon dioxide metabolism and rebreathing; and metabolism in anaesthesia and the theory of anaesthesia. In epidemiology, Snow investigated the relationship of water supplies to mortality in cholera during the London epidemic in 1854, which led him to formulate an original and valid theory of the transmission of cholera. Snow's research, which has received less attention than anecdotes concerning his career (e.g., his anaesthetizing Queen Victoria and urging removal of the handle of a contaminated water pump), was always directed towards solving specific problems. The significance of his research is evident in its leading not only to improvements in health care but also to the evolution of anaesthesia and epidemiology as professional disciplines.

Anesthesia, Inhalation↗

PubMed1979