Biomedical subjects
Publications and source records attributed to H Keszler.
High-frequency jet ventilation is a useful new modality of ventilatory support that offers specific advantage in endoscopy, laryngeal surgery, or mechanically ventilating patients with airway leaks. The method produces lower airway pressures and less movement in the operative field and is well tolerated by the patients. It can be applied by transtracheal puncture as an alternative for emergency airway management.
The efficacy of intravenously administered lidocaine 0.75 mg/kg and 1.5 mg/kg to protect against cardiovascular reactions associated with laryngoscopy and tracheal intubation was studied in two comparable groups of ten patients and compared with a similar control group of ten patients given only saline. Following laryngoscopy and tracheal intubation, the 1.5 mg/kg dose afforded complete protection against cardiac arrhythmias of all types. The smaller dose was ineffectual in this respect. While the larger dose caused borderline protection against hypertension and tachycardia, the smaller dose prevented only the rise in systolic blood pressure. Possible mechanisms to account for these observations are discussed. These include a direct myocardial depressant effect, a central stimulant effect, a peripheral vasodilating effect and finally an effect on synaptic transmission.
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A technique of nebulizing lidocaine in the upper airways was developed and its effectiveness in preventing cardiovascular responses to laryngoscopy and intubation was documented. In ten pre-treated patients the average percentage-rise in systolic blood pressure was 10.3 per cent and there were no arrhythmias. The pulse rate increased by 16.8 per cent. In ten control patients, the systolic blood pressure increased by 56 per cent and the incidence of arrhythmias was 40 per cent. The pulse rate increased by 38.8 per cent. The significance and application of these results is discussed and compared to other available methods. The opinion is expressed that the effect of the aerosol, especially as it relates to the suppression of arrhythmias, is partly due to systemic absorption of lidocaine.
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Two comparable groups of ten patients were studied. After nitrous oxide-oxygen fentanyl-pancuronium anesthesia, half the patients were reversed with a titrated dose of naloxone. Even in titrated doses naloxone rapidly abolished residual post-operative fentanyl analgesia in 80 p. 100 of the patients. In the control group none of the patients complained of pain for an average of six to eight hours. Blood gases in the recovery room were practically the same in reversed and non-reversed patients and were satisfactory.