Biomedical subjects
Publications and source records attributed to Z Kalenda.
The closing phase of anesthesia is defined. Some of the hazards of this period are reported and illustrated by capnograms. It is claimed that the dangers arising at the end of anesthesia are insufficiently appreciated.
Different type of periodic respiration are difficult to distinguish clinically although their identification may influence the diagnosis, prognosis and treatment. Often other forms of abnormal respiration are mistaken for periodic. Four capnograms are shown illustrating (1) true Cheyne-Stokes respiration, (2) irregular "pseudo-periodic" respiration a) after fentanyl, and b) in the presence of a brain tumour and (3) regular respiration interspersed with deep sighs which was diagnosed clinically as Cheyne-Stokes respiration. A plea is made for the routine use of capnography in order to provide a visual record of respiration.
Recordings from three patients in cardiac arrest are shown to illustrate the importance of monitoring pulmonary perfusion by means of the capnogram as a continuous guide to the cardiac output achieved by cardiac massage and resuscitation. Such monitoring allows the performance to be adjusted to obtain the maximal result.
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The author reports the case of a premature new-born presenting a respiratory distress syndrome who was ventilated through a tracheal tube and in whom an artificial pneumothorax developed. Capnography quickly provided accurate data allowing an adaptation of therapy.
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Phrenic nerve paralysis frequently follows operations on the neck such as resection of a cervical or first rib. It all too often passes unrecognised or is incorrectly treated, leading to permanent lung damage which may be severe enough as to result in a functional pneumonectomy. This is particularly unfortunate since the phrenic nerve paralysis is usually temporary. Three case histories are described of reversible paralysis of the phrenic nerve in which, due to prompt diagnosis, the ensuing lung changes were either prevented or immediatley treated. Intermittent assisted respiration with a Monaghan respirator was used to provide nebulised inhalations of Mesna several times a day. The method is applicable via a tracheostomy, an endotracheal tube or a simple mouthpiece. The latter is illustrated. The therapy is not hindered by immobilisation of the head and neck and the level of consciousness of the patients is of no importance. Many chest X-rays demonstrate the rapid clearing of the lungs achieved. All three patients were discharged with perfectly normal lungs.
The effects of the analgesics sulfentanil (R 30730) and fentanyl, on autonimic stability, cardiovascular stability, respiratory depression and post-operative behaviour were compared in a standardised anaesthetic technique. Twenty-nine patients undergoing neurological arteriographies, were treated with one or more doses of 0.5 mg fentanyl; 22 patients were treated with an initial dose of 0.05 mg of sulfentanil followed by repeat injections of 0.025 mg, when necessary. The analgesic potency of sulfentanil proved to be 12 times that of fentanyl while (in contrast to fentanyl), the duration of the respiratory depression after sulfentanil did not differ significantly from the duration of optimal analgesia. The effects of both drugs on blood pressure and heart rate were minimal; autonomic stability was excellent. No serious side effects were seen in any of the patients. After sulfentanil analgesia the patients were more rapidly awake and lucid, than after fentanyl-analgesia. Further investigations with this new and promising drug seem to be of great interest.
Seven capnograms are shown demonstrating the invariable fall in the level of expired CO2 which occurs during the operation for the insertion of a Pudenz-Heyer drain for hydrocephalus. The fall occurs when contrast medium is injected down the heart catheter after withdrawal of the guide but never after subsequent injections unless air is present in the syringe. The effect is shown not to be due to a difference in temperature between the contrast medium and the body. A comparison is made with a capnogram recorded during the setting up of an I.V. transfusion in an infant in which a small quantity of air was seen to enter the circulation along the tubing of the butterfly needle. It is concluded that the fall in the capnogram seen during Pudenz-Heyer operations is due to air embolism. The severity of its effect is shown to be proportional to the volume of air injected in relation to body weight. The value of the capnograph as a sensitive monitor of air embolism is emphasised together with the fact that the fall in the capnogram precedes that of the blood pressure or any other recordable effect.
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