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J R Bowie

Publications and source records attributed to J R Bowie.

6 recordsLinked to original sources
PubMed1995

Rebreathing improves accuracy of ventilatory monitoring.

OBJECTIVE: Our objective was to determine if rebreathing would reduce the gradient between arterial and end-tidal CO2 tension during positive-pressure ventilation. METHODS DESIGN: Experimental investigation. SETTING: Anesthesiology laboratory. SUBJECTS: A total of 10 dogs of either sex. INTERVENTIONS: Anesthesia (sodium pentobarbital) and muscle relaxation (pancuronium) were induced and animals were tracheally intubated and ventilated with a standard anesthesia ventilator and breathing circuit with CO2 absorber and then with a Mapleson D circuit with a fresh gas flow rate (VF) equal to alveolar ventilation plus the sampling flow rate of two capnometers. Rebreathing was varied by adjusting the respiratory rate (RR) so that minute ventilation (VE) to VF ratio was 1:1, 2:1, 3:1, and 4:1. RESULTS: CO2 production (ATPD) was determined as the product of expired concentration of CO2 and VE (BTPS). Alveolar ventilation (VA) was calculated by dividing the product of CO2 production and barometric pressure corrected for ambient temperature and water vapor pressure at body temperature by PaCO2. Tidal volume, RR, airway gas temperature, concentration of CO2 in gas at the tracheal tube and inlet/outlet of the mechanical ventilator, body temperature, arterial gas tensions and pH, heart rate, arterial blood pressure, and cardiac output were measured. Minute ventilation, mean arterial blood pressure and end-expiratory CO2 tension (PECO2) (BTPS) were calculated. During positive-pressure ventilation, concentration of inspired CO2 was zero with standard circuitry, and significantly increased with Mapleson D when VE:VF ratio was 1:1 (0.56 +/- 0.19%), 2:1 (1.97 +/- 1.30%), 3:1 (2.56 +/- 1.05%), and 4:1 (3.01 +/- 1.45%) (p < 0.05). PECO2 was 34.8 +/- 3.2 mm Hg during ventilation with the standard circuit, and significantly increased during ventilation with Mapleson D when VE:VF ratio was increased from 1:1 (35.4 +/- 2.5 mm Hg) to 2:1 (40.2 +/- 3.6 mm Hg) and was not further increased at a VE:VF ratio of 3:1 (41.8 +/- 2.7 mm Hg) or 4:1 (41.3 +/- 2.4 mm Hg). The selected fresh gas flow rate was appropriate, because PaCO2 remained unchanged regardless of VE:VF ratio, indicating PaCO2 was dependent on VF, not on VE. The gradient between PaCO2 and PECO2 during ventilation with the standard circuit was 6.6 +/- 3.0 mm Hg; during ventilation with Mapleson D, it decreased significantly when VE:VF ratio was increased from 1:1 (6.5 +/- 3.6 mm Hg) to 2:1 (2.9 +/- 1.5 mm Hg), but was not significantly reduced further at 3:1 (1.7 +/- 1.1 mm Hg) or 4:1 (1.8 +/- 0.5 mm Hg) (p < 0.05). CONCLUSIONS: Rebreathing with a Mapleson D circuit and a VF equal to VA permitted normal CO2 elimination. Arterial PCO2 to PECO2 gradient decreased significantly during rebreathing, thus improving the reliability of capnography for estimating arterial PCO2. Consideration should be given to using the Mapleson D as a rebreathing circuit.

Anesthesia, Closed-Circuit↗
PubMed1993

Absence of a capnogram after positive end-expiratory pressure.

OBJECTIVE: The objective of this study was to evaluate the effect of positive end-expiratory pressure (PEEP) on capnography. DESIGN: The study design was experimental and open, and it was performed in the Anesthesiology Experimental Research Laboratory. METHODS: Six dogs (9.8 +/- 0.8 kg) were anesthetized and intubated. The animals' lungs were ventilated with a tidal volume of 137 +/- 34 ml and a respiratory frequency of 34 +/- 10 breaths/min to produce a PaCO2 of 35 to 45 mm Hg. Application of 20 cm H2O of PEEP was initiated for 1 minute, then repeated twice after 10-minute stabilization periods. Arterial pH and gas tensions were measured, and capnogram, airway gas flow, and airway pressure were recorded continuously. Airway gas flow was electronically integrated to calculate tidal volume. RESULTS: Mean values before application of PEEP were as follows: pHa, 7.37 +/- 0.04 mm Hg; PaCO2, 37.1 +/- 3.2 mm Hg; PaO2, 93.4 +/- 1.6 mm Hg; and PETCO2, 32.0 +/- 3.5 mm Hg. Compliance of the ventilator circuit was 3.3 ml/cm H2O. Mean deflation lung-thorax compliance was 41.5 +/- 10.3 ml/cm H2O. After application of PEEP, no capnogram was reported for 1 to 6 breaths, an average of 2.7 +/- 1.8 breaths. CONCLUSION: These results demonstrated that absence of gas flow immediately after the application of PEEP may transiently abolish a capnogram when the lung volume increases.

Anesthesia, Inhalation↗
PubMedDate not supplied

A randomized, double-blind pilot study examining the use of intravenous ondansetron in the prevention of postoperative nausea and vomiting in female inpatients.

STUDY OBJECTIVE: To compare the efficacy and safety profiles of intravenous (IV) ondansetron (two 8 mg doses 8 hours apart) and a placebo when used in the prevention of postoperative nausea and emesis (vomiting or retching). DESIGN: Randomized, double-blind, placebo-controlled, parallel, multicenter pilot study. SETTING: Four university hospitals in the United States. PATIENTS: Two hundred seven women scheduled to undergo inpatient surgical procedures during general anesthesia. INTERVENTIONS: Patients were randomized to receive, in a double-blind fashion, either two 8 mg doses of IV ondansetron or a placebo. The first study drug dose was administered before induction of anesthesia; the second dose was given 8 hours later. Each study drug dose was admixed with normal saline to 20 ml and administered IV over 2 to 5 minutes. Vital signs were monitored immediately before and 1 minute after completion of the study drug infusion. MEASUREMENTS AND MAIN RESULTS: For the 24-hour period following operation, 60% of the patients who received ondansetron and 26% of the patients who received the placebo were emesis-free (p < 0.001). Subanalyses based on patients' previous history of general anesthesia indicated that ondansetron was superior to the placebo in preventing emesis regardless of history [66% vs. 33% in patients who had never had general anesthesia or had had no nausea or emesis following previous anesthesia (p = 0.001) and 50% vs. 17% in patients who had nausea or emesis following previous anesthesia (p = 0.005)]. Ondansetron also was superior to the placebo for the prevention of nausea over the 24-hour study period regardless of anesthesia history. Ondansetron was generally well tolerated. The adverse event, vital sign, and clinical laboratory test profiles were similar to those for the placebo. No patient who received ondansetron had untoward changes in central nervous system function, including sedation. CONCLUSIONS: Prophylactic IV ondansetron appears to be safe and causes a significant reduction in the frequency and severity of postoperative nausea and emesis.

Adolescent↗