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Results for “INTUBATION, INTRATRACHEAL”

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PubMed2005

Multivariate analysis of the risk for pulmonary complication after gastrointestinal surgery.

AIM: To identify the risk factors for postoperative pulmonary complications (PPC) after gastrointestinal surgery. METHODS: A total of 1 002 patients undergoing gastrointestinal surgery in the Second Affiliated Hospital, Sun Yat-Sen University, during December 1999 and December 2003, were retrospectively studied. RESULTS: The overall incidence of PPC was 22.8% (228/1,002). Multivariate logistic analysis identified nine risk factors associated with PPC, including age odds ratio (OR = 1.040) history of respiratory diseases (OR = 2.976), serum albumin (OR = 0.954), chemotherapy 2 wk before operation (OR = 3.214), volume of preoperative erythrocyte transfusion (OR = 1.002), length of preoperative antibiotic therapy (OR=1.072), intraoperative intratracheal intubation (OR = 1.002), nasogastric intubation (OR = 1.050) and postoperative mechanical ventilation (OR = 1.878). Logistic regression equation for predicting the risk of PPC was P(1) = 1/[1+e(-(-3.488+0.039 x Y+1.090 x Rd+0.001 x Rbc-0.047 x Alb+0.002 x Lii+0.049 x Lni+0.630 x Lmv+0.070 x Dat+1.168 x Ct))]. CONCLUSION: Old patients are easier to develop PPC.

Adolescent↗

PubMed1999

[A surgically treated case of giant pseudoaneurysm arising as a complication following carotid endarterectomy].

We reported a case of giant pseudoaneurysm (PA) originating at the left extracranial internal carotid artery after carotid endarterectomy (CEA). A 60-year-old man underwent CEA for severe stenosis of the left internal carotid artery. A day after the operation, a left cervical painful and pulsatile mass beneath the operative scar was noticed. Soon after that, the patient showed dyspnea, and intratracheal intubation was carried out. 6 days after CEA, a painful swelling reoccurred. A left carotid angiogram visualized a 5 x 5 cm sized PA in the region of the left carotid bifurcation and demonstrated patency of the two major carotid branches. After a balloon catheter had been inserted and inflated at the carotid bifurcation, the patient underwent a second operation. The bleeding from arteriotomy was well controlled by the inflated balloon catheter at the carotid bifurcation. The continuous SURGILENE suture appeared to be disrupted and a saccular PA was found to have arisen from a defect on the lateral surface of the carotid bifurcation. The suture was completely removed and arteriotomy was closed with a continuous SURGILENE suture again and some single sutures were added. A PA arising as a complication following CEA is rare, but the possibility of PA after CEA should be considered in any patient presenting with a painful or/and pulsatile mass in the neck at any time interval following the operation. Angiography at the early post-op stage is necessary to rule out the various complications after CEA. To control the bleeding, the balloon catheter was thought to be very useful.

Aneurysm, False↗

PubMed1998

[Choices of anesthesia in operations of extraction of foreign body in esophagus].

In order to probe the anesthetic methods of extracting foreign body in esophagus and improve operative effect, potentiated surface anesthesia and intratracheal intubation anesthesia were applied in operations to 72 cases of foreign bodies in esophagus, and comparative observations were done to these cases. All the cases had their foreign bodies extracted smoothly and no serious complications occurred. We consider that each anesthetic method has its advantage. The former is suitable for the adolescents and adults, the latter is suitable for the young children who have foreign bodies in esophagus and difficult breathing.

Adolescent↗

PubMed1975

Investigation of alveolar macrophages from rats exposed to coal dust.

Rats were exposed to the inhalation of coal dust from either Utah (low prevalence coalworkers' pneumoconiosis (CWP)) or Pennsylvania (high prevalence CWP). Rats were sacrificed, the lungs removed and lavaged to obtain free cells. The number of alveolar macrophages recovered from rats inhaling these two coal dusts (exposures up to 4 months) was not remarkably different from the number recovered from rats inhaling filtered room air. This is in contrast to results obtained after intratracheal intubation of the dust. The capacity of the lavaged cells to phagocytize and kill bacteria decreased after exposure to either dust. The activity of certain enzymes also decreased.

Acid Phosphatase↗

PubMed2002

[Anesthetic management for a patient with Charcot-Marie-Tooth disease using propofol and nitrous oxide].

A 65-year-old woman who had been diagnosed as having Charcot-Marie-Tooth disease (CMTD) 8 years ago and was scheduled to undergo excision of a spinal tumor in the prone position. General anesthesia using propofol was selected as the anesthetic method in order to avoid possible occurrence of malignant hyperthermia due to inhalation anesthetics. The patient was given 80 mg of propofol for anesthetic induction, and then propofol was infused at a rate of 4-5 mg.kg-1.h-1 with intermittent administration of fentanyl (total dose of 0.25 mg) for anesthetic maintenance. Vecuronium 4 mg was injected for intratracheal intubation, and then vecuronium 1 mg was injected at 50 min intervals. The operation proceeded uneventfully. The necessary time for anesthesia was over 460 minutes. There was no delay in wakening, and the patient experienced no problems in the postoperative course. Intravenous anesthesia using propofol is thought to be a safe and effective method of anesthesia for patients with CMTD.

Aged↗

PubMed2002

[Effects of intraperitoneal CO2 insufflation on hemodynamics and oxygen consumption during intravenous propofol anesthesia combined with epidural block].

OBJECTIVE: To investigate the effects of intraperitoneal CO2 insufflation on the hemodynamics, oxygen consumption (VO2) and carbon dioxide production (VCO2) during intravenous anesthesia with propofol in combination with epidural block. METHODS: Intratracheal intubation was performed after rapid induction of anesthesia and mechanical ventilation was given. Maintenance of anesthesia was achieved using continuous intravenous propofol infusion (2 mg/kg/h) ?N2O inhalation and intermittent epidural administration. Indices of hemodynamics and respiratory function were collected 5 min before induction, 1 min before CO2 insufflation, and 5, 10, 20, 30, 40, 50, 60 min after the start of insufflation and 5 min after the termination of insufflation. RESULTS: The mean arterial pressure (MAP), heart rate (HR), end-tidal PCO2 (P(ET)CO2), VO2 and VCO2 1 min before insufflation were markedly reduced(P<0.01), compared with those recorded before induction. MAP and HR did not undergo any conspicuous changes during CO2 insufflation and 5 min after insufflation termination. Compared with that 1 min before insufflation, PETCO2 was significantly increased 20 min after the start of insufflation (P<0.01), and subsequently carried on the increase though of a lesser scale. VO2 and VCO2 gradually rose after the start of insufflation, and VO2 presented a significantly elevation (P<0.01) 10 min after the insufflation while VCO2 did not show this marked increase(P<0.05) till 20 min after the insufflation in comparison with the levels before insufflation. Subsequently, VO2 continued to rise and VCO2 also retained the increase but of smaller magnitude. CONCLUSION: Intravenous propofol anesthesia combined with epidural block assisted by well-managed excessive ventilation before insufflation can alleviate the adverse effects of CO2 insufflation on respiratory and circulatory systems.

Analgesia, Epidural↗

PubMed2003

[Self-expandable metallic stent for unresectable malignant esophageal stricture].

Intraesophageal stenting using a self-expandable metallic stent is currently the first choice for patients with unresectable malignant stricture of the esophagus to improve their quality of life because of its efficacy and less invasiveness. Two types of stent are commercially available in Japan. The Ultraflex stent (Boston Scientific Co. Ltd.) is more flexible and less expandable than the Cook-Z stent (Wilson-Cook Co. Ltd.). Care should be taken based on the position of the stricture. Stenting in the cervical esophagus may cause discomfort. Stenting for a lesion adjacent to the airway may cause airway obstruction. Therefore airway stenting or provision for emergency intratracheal intubation is necessary. A stent with an antireflux mechanism would be effective in preventing gastroesophageal reflux following stenting at the esophagogastric junction. The development and legal approval of a stent with antireflux mechanism are expected. Some reported that anticancer treatment after stenting was effective, and some radiologists cautioned against the risk of radiation after stenting. The safety and efficacy of anticancer treatment after stenting remain to be clarified.

Esophageal Neoplasms↗

PubMed1992

[A successful repair of the left ventricular rupture and tracheo-esophageal fistula complicated after mitral valve replacement--a case report].

A 59-year-old woman having mitral stenosis with left atrial thrombus, was admitted to our department and uneventful mitral valve replacement was performed. After weaning from the cardiopulmonary bypass, massive pericardial bleeding was encountered and the heart soon arrested. CPB was reinstituted after thirty minutes. The diagnosis was the left ventricular rupture (Miller Type III), and the direct closure was successfully performed. The patient was complicated with renal and heart failures, which were well managed by the peritoneal dialysis and intraaortic balloon pumping. Long-term intratracheal intubation, however, was required due to the respiratory failure, and tracheostomy was done on the seventeenth postoperative day. The patient was also complicated with mediastinitis, the cause of which was considered to be the tracheo-esophageal fistula (TEF) diagnosed by esophagoscopy and bronchoscopy. Gastrostomy and continuous mediastinal lavage were performed but the TEF was not closed. Thus, the direct suture of the esophageal fistula orifice and the resection of four tracheal rings followed by the direct end-to-end anastomosis were performed on the 102nd postoperative day. After the second operation, the patient greatly improved, and was discharged eighty-seven days later, presenting only slight LV posterior wall hypokinesis but no tracheal stenosis.

Female↗

PubMed2005

[Choice and administration sequence of antiepileptic agents for status epilepticus and frequent seizures in children].

We investigated the sequence of the administration, the efficacy and the safety of antiepileptic drugs (AED) given intravenously for the treatment of status epilepticus and frequent seizures in children. Our institute has a recommended sequence of AED administration for treatment of status epilepticus: the first-line agent is diazepam (0.3 - 0.5 mg/kg administered intravenously, once or twice). The second-line drugs include midazolam (0.15 - 0.4 mg/kg intravenously, once or twice, and if necessary, followed by continuous infusion at 0.06 - 0.18 mg/kg/hour), lidocaine (1 - 2 mg/kg intravenously, once or twice, and if necessary, followed by continuous infusion at 2 - 4 mg/kg/hour) and phenytoin (10 - 20 mg/kg, infused slowly). For those patients who previously experienced a seizure which was refractory to diazepam but responsive to the second-line agent, it was recommended to use the second-line agent as a first-line agent. When seizures were refractory to the first and second-line agents, thiopental was administered (3 - 10 mg/kg intravenously, and if necessary, followed by continuous infusion at 2 -5 mg/kg/hour). The etiologies of 177 occasions of status epilepticus and frequent seizures were categorized into two groups:epilepsy (n = 95) and situation-related seizures (n = 82). Situation-related seizures included febrile seizures (n = 44), acute encephalopathy/encephalitis (n = 31) and benign infantile convulsions (n = 7). The ages of the patients ranged from 0.1 to 18.4 years (average +/- SD:3.69 +/- 3.15 years). Diazepam was administered as the first-line drug on 157 of 177 occasions (88.7%). On 116 occasions the second-line agents were administered. Midazolam and lidocaine were injected as the second-line agent on 54 (46.6%), and on 33 (28.4%) occasions, respectively, although both midazolam and lidocaine injections were off-label use for seizure control in Japan. Thiopental was used as the third to fifth-line agent. Effective ratios (effective occasions/total occasions) of each drug were the following: thiopental 19/21 (90.4%), midazolam 57/99 (57.6%), lidocaine 25/60 (41.7%), phenytoin 16/41 (39.0%), diazepam 59/164 (36.0%). Thiopental was statistically more effective than midazolam, lidocaine, diazepam or phenytoin (p < 0.01), and midazolam was statistically more effective than diazepam (p < 0.01) or phenytoin (p < 0.05). Administration of thiopental caused complications more frequently than the other agents (p < 0.01): The complications by thiopental were severe in some cases requiring intratracheal intubations and artificial ventilation. From the viewpoint of both efficacy and safety, midazolam should be recommended as one of the first-line agents for status epilepticus.

Adolescent↗

PubMed1991

Ultrastructural changes in rat lungs exposed to combinations of cadmium, zinc, copper, and nickel.

The morphological effects of single intratracheal intubation of cadmium oxide (CdO) with oxides of zinc (Zn), copper (Cu), and nickel (Ni) at their threshold limit values on alveolar macrophages and type II cells were studied. The combinations used were: CdO + ZnO (0.1 mg + 5.0 mg); CdO + CuO (0.1 mg + 0.2 mg); and CdO + NiO (0.1 mg + 1.0 mg). Rats sacrificed after one week recovery period showed distinct morphological changes. Alveolar macrophages and type II cells exposed to CdO and ZnO showed an increase in number, shape, and size of vacuolar phagolysosomes. Multivesicular bodies and lamellar bodies were also seen, as well as the lack of distinct nucleoli. The CdO/CuO combination showed an increase in the number of dense vacuolar phagolysosomes and large aggregates of multivesicular bodies. Hypertrophy of mitochondria was also evident in this combination. The CdO/NiO combination showed more distinctive changes compared to the other two combinations in lysosomes, membranous whorls, multivesicular bodies, residual bodies, and number of mitochondria. Our findings using combination exposures of CuO and ZnO with CdO indicate the existence of competitive inhibition resulting in some form of protective action. On the other hand, the CdO/NiO exposure seemed to be additive showing structural modifications, premature aging, faster degeneration, and release of abnormal membrane structures.

Animals↗

PubMed1990

[The causes of prolonged postoperative respiratory care in mitral valve disease with a giant left atrium].

Whether a giant left atrium in mitral valve disease itself prolongs postoperative respiratory care or does not is an important problem. We investigated it in 39 patients who underwent MVR without plication of the left atrium. A giant left atrium (GLA) was defined when CT-LA volume exceeded 300 ml by rapid sequential CT or left atrial diameter exceeded 60 mm by echocardiography. According to this criteria, the 39 patients were divided into two groups: 18 patients of GLA group and 21 of non-GLA group. Eight GLA (44%) and 11 non-GLA patients (52%) needed postoperative respiratory care with intratracheal intubation for more than 24 hours. Four GLA (22%) and 2 non-GLA patients (9.5%) needed reintubation. There was no significant difference between the two groups concerning the duration of postoperative respiratory care and the frequency of reintubation. The reintubated patients had three prominent preoperative clinical profiles, such as poor general condition, poor cardiac function and poor respiratory function. Consequently, it is concluded that in mitral valve disease with a GLA the prolongation of postoperative respiratory care is largely due to poor cardiac and respiratory function rather than to the compression to the bronchus by a GLA.

Cardiomegaly↗

PubMed1989

[Respiratory failure after thymectomy in myasthenia gravis: evaluation of preoperative influencing factors and preventive managements against postoperative respiratory dysfunction].

Postoperative respiratory function was evaluated in 94 patients with myasthenia gravis after thymectomy. Preoperative clinical and pulmonary function data were submitted to statistical analyses. The duration of respiratory support and intratracheal intubation time were significantly correlated to % vital capacity, the clinical stage of myasthenia gravis, and the clinical stage of thymoma. Statistical analyses proved that anticholinesterase drugs taken in immediate postoperative period contributed to the improvement of postoperative respiratory function, and non-depolarizing muscle relaxants, i.e. d-tubocurarine which had been considered to be contraindicated in myasthenia gravis was found to be beneficial immediately after the operation in patients with severely deteriorated respiratory function preoperatively.

Cholinesterase Inhibitors↗

PubMed1989

[First-aid of serious trauma at the emergency room (an analysis of 144 cases)].

From 1983 to 1987 there were 144 patients with serious trauma who were given first-aid in the emergency room of our hospital. Sixty of them died (41.7%). The mortality was 56% (1983-1984) and 29.8% (1985-1987) (P less than 0.05). Our experience included: 1. to perform intratracheal intubation or tracheostomy at once for decreasing the mortality of the comatose or asphyxial patients, 2. to transfuse large quantity of liquid quickly and enough quantity of blood for treating shock; 3. learn to be more familiar with multiple injury for reducing diagnostic mistake; 4. to provide with excellent medical services and raise the efficiency of first-aid for decreasing the mortality of serious trauma in the emergency room.

Abdominal Injuries↗

PubMed1987

[Surgical management of fresh injuries of the outer ligament of the upper ankle joint in local anesthesia].

Fresh, isolated external ligament ruptures in adults have been surgically treated almost without exception under local anaesthesia for more than a year now at the Department of Surgery of the Rhenish-Westphalian Technical University (RWTH) at Aachen. No complications due to anaesthesia developed in these 119 patients; all of them expressed great satisfaction at this mode of surgical approach. What is more: this method is less costly and requires less personnel than surgery under peridural anaesthesia or intratracheal (intubation) anaesthesia. Hence, in the authors' opinion, isolated fresh ruptures of the outer ligaments of the ankle joint should be operated on more often under local anaesthesia than is actually being done at present.

Adolescent↗

PubMedDate not supplied

[Experimental left atrial infarct].

Electrical changes produced by an experimental left atrial infarction were studied in 15 mongrel dogs, anesthetized by sodium pentobarbital intravenously and submitted to intratracheal intubation, medical sternotomy and heart exposition without open the pericardial sac. 5 to 8 ml of alcohol 96 degrees were infiltrated into left atrial myocardium by means of a thin needle introduced superficially and parallel to the visceral pericardium. Left atrial damage reduces the electromotive, forces corresponding to the anterolateral portions of the left atrium giving rise to QS or QR slurred P waves with very delayed activation when left portion of interatrial band was damaged. Surface ECG records bimodal wide P waves with or without a qp wave in V2-V4 leads, associated to STa elevation in lead a VL and higher leads in the fourth and third left intercostal spaces at the vertical line of V4. QTac interval is more prolonged in right than in left registries as it was observed in right atrial damage, which implies a more earlier repolarization of left atrium. These data are useful for diagnosis of infarction or myocarditis.

Animals↗

PubMed1978

The respiratory epithelium. III. Histogenesis of epidermoid metaplasia and carcinoma in situ in the human.

The histogenesis of epidermoid metaplasia and carcinoma in situ was analyzed in human bronchial epithelium. The conclusion is that epidermoid metaplasia and carcinoma in situ can result from conversion of mucous cells. This implies the direct transformation of one type of fully differentiated cell to another. The study therefore emphasizes the differentiation potentialities of the mucous cells that can divide and undergo goblet cell hyperplasia and epidermoid metaplasia. Epidermoid metaplasia is a common reaction to injury in the bronchus. In our series of cases it was especially frequent in patients without neoplastic disease who had undergone intratracheal intubation or tracheostomy and who had been maintained on a respirator in the Shock Trauma Unit, University of Maryland. Future studies will be required to distinguish the difference, if any, between epidermoid metaplasia destined to become malignant carcinoma and that which is not. One difference noted in this study was the absence of overt cornification in epidermoid metaplasia in patients without neoplastic disease.

Bronchi↗

PubMed1985

[Serotonergic effect on cerebrospinal fluid production].

Many details concerning CSF production at the choroid plexus remain unsettled, and the control mechanisms on the production are also not yet clarified. In the present study, the association of serotonin in the dynamics of the CSF production was studied. The authors utilized the ventriculocisternal perfusion method developed by Pappenheimer and an automatic continuous measurement technique which was designed by the authors. The experimental animals comprised 48 mongrel dogs weighing 7.0 to 12.0 kg. The animals were inactivated by intravenous injection of Dialferin after intratracheal intubation for generalized anesthesia with N2O, O2 and Halothane. Within about 2-2.5 hours after starting perfusion of the Blue Dextran-Elliott-B perfusion fluid, the optical density reached a plateau, and the CSF production in the control dogs could be calculated. Once the data for the control had been obtained, intravenous administration of 5-hydroxytryptophan (5-HTP), noradrenaline (NA) and acetazolamide (Diamox) was commenced. Administration of various amount of 5-HTP, a precursor of serotonin, reduced the CSF production, that was, after administration of 10 mg/kg, 20 mg/kg, and 30 mg/kg 5-HTP the CSF production reduced by 37.0 +/- 4.4%, 39.9 +/- 3.1%, and 35.2 +/- 5.5% (mean +/- SD), respectively, and no correlation with dose was observed. After administration of 5-HTP, the blood pressure showed unsteady state for about 10 minutes, showing an increase in pulse pressure. It then declined gradually. All these phenomena were within the range of autoregulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetazolamide↗

PubMed1981

Malignant catarrhal fever. I. Response of American cattle to malignant catarrhal virus isolated in Kenya.

Fifty-three American cattle were inoculated with malignant catarrhal fever virus isolated from a wildebeest in Kenya. Three animals showed the mild form of the disease and recovered, and 47 showed the severe form of the disease. The other three did not react. Of the 47 cattle, 28 died, 16 were killed for the collection of specimens and three recovered. The incubation period for the 47 cattle ranged from 16 to 29 days and the course of the fatal disease for 28 cattle averaged three to 23 days. Virus titration of specimens from nine infected steers yielded a mean titer of 10(4)/TCID50 per gm for lymph nodes, 10(3) TCID50 per mL for buffy coats and 10(2.3) TCID50 per gm for spleens. Smaller amounts of virus were found in the liver, kidneys, adrenals and thyroids. Malignant catarrhal fever virus was also found in nasal secretions and saliva of viremic cattle. Viral infectivity was shown in bovine buffy coat cells stored at 4 degrees C for two days but was immediately destroyed upon freezing even when glycerine or dimethylsulfoxide was added. Viral particles were not found in infected animal tissues by electron microscopy. The disease was successfully transmitted in steers by intratracheal intubation and by aerosol inhalation but not by contact.

Animals↗