Anesthesia "R" Us, Inc.
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Biomedical subjects
Publications and source records attributed to R T Chilcoat.
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The liquid/gas partition coefficients of three inhalation anesthetics in Fluosol-DA 20% (Fluosol), a perfluorocarbon blood substitute, were determined in vitro. The high values found (6.68 for halothane, 7.54 for enflurane, and 7.20 for isoflurane) suggested that induction with these agents would be prolonged in patients treated with Fluosol. Induction of isoflurane anesthesia (as a representative agent) at constant inspired concentration was studied in five mongrel dogs before and after replacement of about 25% of each animal's blood volume with Fluosol. Inspired and end-tidal isoflurane and carbon dioxide concentrations were recorded breath by breath, together with cardiac output. There was a significant delay in rise of end-tidal isoflurane concentration after Fluosol infusion. However, because cardiac output could not be held constant during each experiment, and because cardiac output also affects the rate of rise of alveolar anesthetic concentration, a physiological computer model was used to compare the isoflurane blood/gas partition coefficients that must have existed to account for the observed end-tidal levels before and after Fluosol infusion, while taking cardiac output variation into account. Post-Fluosol blood/gas partition coefficients calculated in this way (2.59 +/- 0.51 SD) were significantly different (P less than 0.001) from pre-Fluosol levels (1.45 +/- 0.15 SD) and were not significantly different from post-Fluosol partition coefficients calculated by volume-weighted averaging (2.91 +/- 0.36 SD). This indicates that the delay observed was attributable in large part to increased solubility of isoflurane in blood after addition of Fluosol. Based on their similar liquid/gas partition coefficients in Fluosol, similar delays should occur with halothane and enflurane.
A system is described which concurrently measures, breath-by-breath, the inspired and end-tidal concentrations of five gases, and alveolar and total ventilation. Gas concentrations are measured by means of a quadrupole mass spectrometer and mixed-expired carbon-dioxide concentration, required for the computation of alveolar ventilation, is computed as the volume-weighted average of expired carbon dioxide.
A control system was used to bring the tension of anaesthetic in the brain to any value specified (in MAC units) by the anaesthetist and then maintain it constant until a new value was specified. The control was applied to a volatile agent but allowance was automatically made for the anaesthetic effect of any nitrous oxide concomitantly administered by the anaesthetist. The inspired concentration required to achieve the desired brain tension was calculated from a model of the patient and set automatically on the vaporizer. The quantification of the model was matched to the patient on the basis mainly of body mass and periodic non-invasive measurements of alveolar ventilation and cardiac output. In order to adapt the model to the patient an arterial blood sample was taken every 30 min to obtain the arterial tension of halothane for use as feedback. The system has been tested on eight Alsatian dogs. After omitting results affected by avoidable errors, the SD of the measured-to-computed arterial tension ratio was less than 10%.
A modification of a common commercial Xe-133 ventilation device is described for mechanically assisted ventilation imaging. The patient's standard ventilator serves as the power source controlling the ventilatory rate and volume during the xenon study, but the gases in the two systems are not intermixed. This avoids contamination of the ventilator with radioactive xenon. Supplemental oxygen and positive end-expiratory pressure (PEEP) are provided if needed. The system can be converted quickly for conventional studies with spontaneous respiration.
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Seven Alsatian dogs were anaesthetized with thiopentone, paralysed with pancuronium, and ventilated with 1% halothane in a mixture of air and oxygen in such a way as to maintain Paco2 at 40 mm Hg and Pao2 at 150 mm Hg. From various respiratory and circulatory measurementts the following variables were determined: physiologicaldeadspace, cardiac output, venous admixture, respiratory compliance and resistance, and oxygen and carbondioxide exchcnage. After a controlseries of measurements at a ventilator frequency of was doubled to 50/min and adjustments to tidal volume and inspired oxygen concentration made to maintain constancy of blood gas tensions. The same procedure was followed again at 25/min, l/min and finally at 25/min. At each frequency the I:E ratio was kept at 1/2, the shape of the inspiratory flow waveform was kept constant (a rapid increase followed by a steady decline to zero) and expiration was passive to atmosphere. Mean results showed that physiological deadspace changed relatively little with frequency so that the deadspace:tidal volume ratio increased significantly on changing to 50/min (by 24%) and decreased significantly on changing to 6/min (by 46%). Changes of cardiac output and venous admixture were either not significant or on the borderline of significance and the 95% confidence limits of these changes were within +14%, --12% for cardiac outpur and within plus or minus1.4% of cardiac output for venous admixture. Tt is concluded that, provided Paco2 and Pa02 and mean air way pressure are kept constant, the frequency of ventilation is not important, even over a wide range of values.
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