Acid-base balance controversy. Total-body carbon dioxide titration.
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Biomedical subjects
Publications and source records attributed to P R Levesque.
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A 68-year-old patient was scheduled for a thoracotomy. A double-lumen endobronchial tube was requested by the surgeon to facilitate operating conditions. Initial attempts at intubation by conventional methods were unsuccessful. The proximal ends of a 37F double-lumen tube were then shortened and a 4-mm fibreoptic bronchoscope was passed through the bronchial lumen. The patient's larynx was easily visualized and the bronchoscope was passed into the trachea. The double lumen tube was then advanced over the bronchoscope and correctly positioned. Shortening a double-lumen tube allows the use of a fibreoptic bronchoscope to aid in tracheal intubation in a patient whose larynx is difficult to visualize by conventional methods.
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Every anesthesiologist is aware of the importance of acid-base determinations, but the multiplicity of duties required in clinical anesthesia often leave time for blood-gas measurements at most. The author presents a relatively simple four-step system for more complete interpretation, with biomathematical back-grounding. In summary, he points out that the dominant parameter remains the patient's clinical history in relation to hydrogen ion, Paco2, and bicarbonate.
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