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Biomedical subjects

G A Arndt

Publications and source records attributed to G A Arndt.

18 recordsLinked to original sources
PubMed1999

Wire-guided endobronchial blockade in a patient with a limited mouth opening.

PURPOSE: We report the use of wire-guided endobronchial blockade, a new method of achieving one-lung ventilation, in a patient requiring awake, nasal, fibreoptic intubation for resection of a lung carcinoma. CLINICAL REPORT: A 43-yr-old woman with limited mouth opening, from severe TMJ dysfunction, required a right thoracotomy for right upper lobe wedge resection. One-lung ventilation was accomplished using a new type of wire-guided endobronchial blocker. The device was placed coaxially through the endotracheal tube using a pediatric bronchoscope through a special bronchoscopy port. CONCLUSION: Effective one-lung ventilation was achieved using this system. The system may prove advantageous in clinical situations where placement of double lumen endotracheal tubes or Univent tubes is technically impractical or impossible.

Adult↗
PubMed1999

One-lung ventilation when intubation is difficult--presentation of a new endobronchial blocker.

BACKGROUND: One-lung ventilation utilizing a double-lumen endotracheal tube may be technically difficult or inappropriate in morbidly obese or critically ill patients. In patients requiring awake fiberoptic intubation, double-lumen tube placement may be impossible. Wire-guided endobronchial blockade through a conventional endotracheal tube is a new alternative for these patients. METHODS: A 44-year-old, 133 kg female patient was scheduled to undergo a thoracotomy for transthoracic fundoplication. A wire-guided endobronchial blocker (WEB) was placed following rapid-sequence induction and intubation with an 8.0 OD single-lumen endotracheal tube with the aid of a pediatric bronchoscope. RESULTS: The WEB, using a guiding loop, was placed with ease and allowed effective one-lung ventilation. CONCLUSION: The WEB system allows one-lung ventilation to be achieved with a conventional endotracheal tube. The need for reintubation at the end of surgery is eliminated and endotracheal tube cross-sectional area is conserved.

Adult↗
PubMed1998

Intubation via the LMA using a Cook retrograde intubation kit.

PURPOSE: We report two cases of difficult intubation where a laryngeal mask airway (LMA) was used and changed to a conventional endotracheal tube using a retrograde intubation set. CLINICAL FINDINGS: In two patients, following induction of anaesthesia, the trachea could not be intubated in the conventional fashion with a blade. In both patients an LMA was inserted to achieve an airway. In both patients intubation with a conventional endotracheal tube was required. A Cook Retrograde Intubation Kit and fibreoptic bronchoscope were used to change the LMA to conventional endotracheal tube without problems. CONCLUSION: The Cook retrograde intubation allows an LMA to be replaced with an endotracheal tube with an ID greater than 6 mm with a #3 or 7 mm with a #5 LMA. This technique places an exchange stylet into the airway which is superior to a conventional guidewire. This method allows the airway to be maintained until the LMA is exchanged with an endotracheal tube. Anaesthesia may be maintained and the airway instrumented without difficulty using this technique.

Adult↗
PubMed1997

Postoperative reparalysis after rocuronium following nebulized epinephrine.

PURPOSE: We report a case of postoperative reparalysis in the recovery room, following nebulized epinephrine. The patient was pharmacologically reversed with edrophonium after paralysis with rocuronium. CLINICAL FINDINGS: A 12-yr-old girl developed postoperative reparalysis following the intraoperative administration of rocuronium. A total of 0.92 mg.kg-1 rocuronium was administered. After surgery, pharmacological reversal was achieved with 20 mg edrophonium with 0.15 mg atropine sulfate iv 35 min after the last administration of rocuronium. Muscular relaxation was monitored using an ulnar peripheral nerve stimulator (PNS). After reversal, a full train-of-four and sustained tetanus at 50 Hz were present. In the recovery room, following nebulized epinephrine, the patient became apneic. The patient was paralyzed and an ulnar PNS demonstrated only one faint twitch. The paralysis was reversed with 1.5 mg neostigmine with 0.3 mg glycopyrrolate. CONCLUSION: Postoperative reparalysis following rocuronium may be a cause of postoperative respiratory distress. The definitive diagnosis is made using PNS and observing the response to pharmacological reversal. Nebulized epinephrine may have a previously undescribed role in the development of postoperative reparalysis.

Administration, Inhalation↗
PubMed1996

Paradoxical vocal cord motion in the recovery room: a masquerader of pulmonary dysfunction.

PURPOSE: We report a case of paradoxical vocal cord motion as an unusual cause of postoperative stridor and wheezing. A means of diagnosis and management is discussed. CLINICAL FINDINGS: A 71-yr-old man developed paradoxical vocal cord motion following uncomplicated hip replacement. He was treated with standard therapy for postoperative stridor and wheezing. After extensive evaluation, a flexible fibreoptic laryngoscope was used and the vocal cords noted to move paradoxically. This was the cause of his postoperative stridor and wheezing. Paradoxical vocal cord motion should be suspected as a cause of postoperative stridor and wheezing when the airway is easily maintained by a bag and mask, there is previous history of psychological problems, and there exists an unexplained history of previous postoperative airway distress. The definitive diagnosis may be made using a fibreoptic laryngoscope. In this patient, intubation was deferred and a plan of conservative therapy pursued. CONCLUSION: Paradoxical vocal cord motion is an unusual cause of postoperative respiratory distress. A definitive diagnosis may be made by the use of a flexible fibreoptic laryngo-scope using topical anaesthesia.

Aged↗
PubMed1995

A linear approximation of Brody's equation to predict oxygen consumption in adult humans.

OBJECTIVE: The objective of our study was to derive a linear approximation to Brody's equation for oxygen consumption as a simpler alternative for the clinician. METHODS: The approximation was derived by using calculus to construct a line tangent to Brody's equation at 81 kg. RESULTS: The linear approximation was derived to be: VO2 = (2.5w + 67.5) ml/min, where w is the subject's weight in kilograms. The error introduced by this linear approximation is 10.9% at 30 kg and 1.35% at 120 kg. CONCLUSIONS: This linear equation may have utility for approximating oxygen consumption when an approximation is required, as in closed circuit anesthesia. The utility of this equation is that it is linear and produces a result similar to Brody's equation.

Adult↗
PubMedDate not supplied

Computer-assisted continuous infusion for the delivery of target-controlled infusions of propofol during outpatient surgery.

Propofol was administered intravenously using a first-order, three-compartment, computer-controlled infusion pump (CCIP) based on the Ohmeda 9000 syringe pump. The CCIP system produced a target-controlled infusion (TCI) based on the estimated blood concentration (EBC). Twenty-five patients undergoing ambulatory surgery completed the study. The induction EBC was 4.72 +/- 0.28 micrograms/ml, and was achieved rapidly with minimal hemodynamic changes. The emergence EBC was 1.55 +/- 0.21 micrograms/ml, and the discharge EBC was 1.06 +/- 0.22 micrograms/ml. The EBC, together with clinical signs, allowed for predictable inductance and emergence from anesthesia using propofol.

Adolescent↗