PubMed · 8679376
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I F Russell, M Wang. 1996. Isolated forearm technique.. https://doi.org/10.1093/bja%2F76.6.884
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UNLABELLED: Pulmonary aspiration of gastric acid is a complication that occurs during anesthesia. The effects of the often used anesthetics on the inflammatory response after aspiration of acid are not known. We examined the effects of three different inhaled anesthetics--halothane, enflurane, and isoflurane--as well as parenteral ketamine, on the associated immediate mortality, alveolar protein leakage, and morphometric changes after intrapulmonary instillation of acidic solution in rats. Animals in deep state of anesthesia had a higher mortality after the instillation of acidic solutions than those in lighter stages (82.5% vs 31.6%). Protein leakage over 5 h was greater in the animals receiving volatile anesthetics (range 0.9-1.2) compared with those receiving ketamine (0.6 +/- 0.05). Desferoxamine did not decrease protein leakage in acid-injured animals (1.1 +/- 0.06 vs 1.02 +/- 0.08). Furthermore, volatile anesthetics resulted in an increase in the acute inflammatory response and leukocytic infiltration compared with ketamine in acid-injured lungs. We conclude that the administration of inhaled anesthetics was associated with exacerbation of an acute inflammatory response after aspiration of acidic solution. Lung injury was not increased with ketamine anesthesia. This difference was the result of the hypotensive effects of inhaled anesthetics. IMPLICATIONS: This study reveals that the use of inhaled anesthetics aggravates inflammation secondary to gastric aspiration and should be avoided on diagnosis of the situation.
OBJECTIVES: My objective was to revisit the issues and approaches raised in a seminal article published in Pediatrics in 1976 by A. Frederick North, Jr, entitled "When Should a Child Be in the Hospital?" Dr North proposed a set of nine criteria to guide the evaluation of appropriateness of admission to hospital. These were based on a core assertion that, "The need to hospitalize a child is dependent on the special services which the child requires rather than upon the diagnosis." This original work antedated more recent activities and publications in the area of appropriateness evaluation as applied to pediatrics (such as the Pediatric Appropriateness Evaluation Protocol), but is more context-specific than later works in the field. METHODS: A review of the literature concerning temporal trends in hospital use for children in North America was undertaken. This was done to place some of the subsequent observations in a macrocontext of overall trends in hospital use. A review of the English language literature focusing on alternatives to hospitalization and contextual evolution affecting patterns of hospital care for children is presented. Factors influencing each of the nine admission criteria proposed by North are reviewed and discussed in turn. RESULTS: Overall rates of hospitalization declined by 46% and 41% in the United States and Canada, respectively, during the 1971 to 1993 interval. The relative composition by diagnostic category in two specific pediatric hospital settings also evolved substantially during the 2 decades. Many of North's specific criteria required extensive revision or updating to match the contextual realities of the 1990s. CONCLUSIONS: Although important overall shifts have occurred in the absolute levels and relative composition of pediatric hospitalization, Dr North's core assertion, relating to the need for specific services driving the need for hospitalization, has largely stood the test of time.
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