[Continuous spinal anesthesia].
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Biomedical subjects
Publications and source records attributed to D Olshwang.
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The paratracheal audible respiratory monitor (PTARM) was assessed in anaesthetized patients who were not intubated. Its working principle is simple: the sound generated by the passage of air between the vocal cords is picked up by a microphone placed on the patient's neck; the electronic signal is then amplified and changed into an audible one. It can also be recorded. This monitor was compared to others already available, Transcor, which monitors breathing sounds using a stethoscope as transducer, and Thermistor, which monitors the changes in air temperature due to air movement during breathing. The PTARM does not tie the anaesthetist down to the patient's bed, as do the precordial or oesophageal stethoscopes. Its usefulness in detecting aspiration is under investigation. It is a reliable, noninvasive and cheap breath-to-breath respiratory monitor, which can also be used in intubated patients.
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Two cases are presented of pulmonary barotrauma developing during cardiopulmonary resuscitation. This was attributed to high airway pressures developed during ventilation. One patient was ventilated with a self-inflating bag and the second with the Robertshaw demand valve. Both devices were used appropriately. Three other cases of pulmonary barotrauma during resuscitation have been recorded with the use of the latter device during CPR by ambulance personnel in Israel. The Robertshaw demand valve may generate excessively high airway pressures during normal use or when malfunctioning. For these reasons, the use of the Robertshaw demand valve has been discontinued in the Israeli Emergency Medical Services ambulances.
Epidural injections of a 2 mg morphine were given to 10 patients with severe acute or chronic pain. All cases had considerable amelioration of pain, which commenced within 2-3 min, reached a peak in 10-15 min, and was effective for 6-24 h. It is suggested that the morphine reached the subarachnoid space and produced its effect by direct action on the specific opiate receptors in the substantia gelatinosa of the posterior-horn cells of the spinal cord.
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