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At least 19 recordsLinked to original sources
PubMed1975

Cardiovascular effects of intraperitoneal insufflation with carbon dioxide and nitrous oxide in the dog.

Cardiovascular changes caused by intraperitoneal insufflation with CO2 or N2O were measured in 15 mongrel dogs. Moderate progressive increases in intra-abdominal pressure (to 40 mm Hg) with either gas produced increases in mean arterial, right atrial, pleural, and femoral-vein pressures. Cardiac output and inferior vena caval flow were momentarily increased following the commencement of insufflation. However, both flows decreased precipitously as insufflation pressure was increased. At an intra-abdominal pressure of 40 mm Hg cardiac output and inferior vena caval flow were reduced more than 60 per cent in most cases. Peripheral resistance increased by approximately 200 per cent. Upon sudden release of abdominal pressure cardiac output and inferior vana caval flow increased but then returned to pre-insufflation values within seconds. Directly measured right atrial pressure increased with increasing insufflation pressure, but calculated transmural right atrial pressure decreased with the increase in intra-abdominal pressure. Insufflation with CO2 produced significant increases in PaCO2. However, cardiostimulatory effects due to elevated blood CO2 levels were not seen. The data from this study indicate that intraperitoneal insufflation produces serious hemodynamic alterations which are manifested by low cardiac output and elevated total peripheral resistance. In addition, directly measured right atrial pressure cannot be used clinically as an indicator of venous return to the heart since it reflects a composite of pleural and intra-abdominal insufflation pressure. (Key words: Anesthetics, gases, nitrous oxide; Carbon dioxide, intraperitoneal; Surgery, intraperitoneal insufflation; Heart, function, intraperitoneal insufflation.).

Acid-Base Equilibrium↗
PubMed2026

High-Flow Nasal Oxygen and the Risk of Gastric Insufflation: A Systematic Review and Meta-Analysis Supplemented by Narrative Synthesis.

High-flow nasal oxygen (HFNO) generates positive airway pressure, raising concerns about gastric insufflation and aspiration risk. Although most studies report minimal or no gastric distension, some suggest significant changes. This systematic review and meta-analysis applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to evaluate the effect of HFNO on gastric insufflation and related markers across clinical settings. We searched Medline, Embase, Emcare, and CINAHL through August 2025 for studies reporting qualitative or quantitative markers of gastric insufflation during HFNO use, including comet-tail artifacts, antral cross-sectional area, and gastric volume. Eligible designs included randomized trials, observational and volunteer studies, and case reports. Methodological quality was evaluated using the Mixed Methods Appraisal Tool, and certainty of evidence was rated with GRADE. Meta-analysis was performed for outcomes reported in two or more studies. Six randomized trials, five observational studies, two volunteer studies, one case series, and two case reports were included. Observational studies primarily assessed outcomes before and after HFNO intervention. Pooled analysis of four randomized controlled trials (RCTs; n = 375) showed HFNO significantly reduced gastric insufflation compared with face-mask ventilation during elective peri-intubation (risk ratios [RR] = 0.32; 95% confidence interval [CI], 0.19-0.52; P < .00001; I 2 = 0%), rated moderate-certainty. For antral cross-sectional area, pooled analysis of three RCTs (n = 318) found no significant difference between HFNO and face-mask ventilation (MD -0.33 cm 2 ; 95% CI, -0.72 to 0.05; P = .09; I 2 = 74%), rated moderate-certainty. Observational studies assessing pre- and post-HFNO changes showed no significant increase in antral cross-sectional area (MD 0.08 cm 2 ; 95% CI, -0.29 to 0.45; P = .67; I 2 = 0%) and no significant change in gastric liquid volume (MD -0.01 ml/kg; 95% CI, -0.07 to 0.06; P = .80; I 2 = 0%), both rated low certainty. Nonpooled data suggested possible increases in critically ill patients, but the evidence was of very low certainty. A single study assessing microaspiration found HFNO reduced gastroesophageal reflux and prevented microaspiration compared with face-mask ventilation. No clinically significant aspiration events were reported across studies. Moderate-certainty evidence supports HFNO as safe regarding gastric insufflation and antral cross-sectional area in most elective and procedural contexts. Low-certainty evidence suggests no increase in gastric volume. Caution is warranted due to limited, low-to-very-low-certainty evidence at higher flow rates and among critically ill patients. Larger multicenter trials and robust observational studies are necessary to confirm safety in these settings.

Humans↗
PubMed2026

Efficacy and Safety of Mechanical Insufflation-Exsufflation in Invasively Ventilated Critically Ill Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Mechanical insufflation-exsufflation (MI-E) is increasingly used in invasively ventilated adults in the intensive care unit (ICU), yet its therapeutic efficacy and safety remain uncertain due to inconsistent evidence. AIM: To synthesize evidence on the clinical efficacy and safety of MI-E in this population and to examine methodological and clinical heterogeneity underlying reported outcomes. STUDY DESIGN: A systematic review and meta-analysis of randomized studies (including RCTs and randomized crossover trials), conducted following PRISMA guidelines, with risk of bias assessed using the Cochrane risk-of-bias tool. RESULTS: Five randomized controlled trials involving 310 patients were included. Meta-analysis showed that mechanical insufflation-exsufflation (MI-E) significantly increased sputum clearance (SMD&#x2009;=&#x2009;0.63, 95% CI, 0.32-0.93; p&#x2009;<&#x2009;0.00011; I2&#x2009;=&#x2009;38%) without affecting oxygenation (MD&#x2009;=&#x2009;0.28, 95% CI, -0.53 to 1.09; p&#x2009;=&#x2009;0.50; I2&#x2009;=&#x2009;9%). Data on respiratory mechanics, ventilation duration and ICU stay could not be pooled. No serious adverse events were reported. CONCLUSIONS: MI-E significantly improves sputum clearance in invasively ventilated critically ill adults, with no severe adverse events reported in the included studies. Its effects on other outcomes remain inconclusive due to limited data and heterogeneity. Standardized protocols and larger trials are needed. RELEVANCE TO CLINICAL PRACTICE: Clinicians may consider MI-E as an adjunct for respiratory secretion management. Application should be guided by structured patient assessment and individualized parameter adjustment. Future research should standardize interventions and target well-defined patient subgroups to inform clear practice guidelines. TRIAL REGISTRATION: The review protocol was registered in the International Prospective Register of Systematic Reviews, with registration number CRD42023403299.

Humans↗
PubMed1979

Acid-base balance during laparoscopy. The effects of intraperitoneal insufflation of carbon dioxide and nitrous oxide on acid-base balance during controlled ventilation.

During laparoscopy the carbon dioxide used to achieve a pneumoperitoneum is absorbed from the peritoneal cavity into the blood. The object of the present study was to clarify certain aspects concerned with anesthetic and ventilatory techniques, mostly in connection with the comparison between the effects of insufflation of either carbon dioxide or nitrous oxide. Anesthesia included ventilation with a volume controlled ventilator in curarised patients. Respiratory volumes were calculated according to the patient's body area. The results show a sharp rise in PaCO2 and a fall in pH after intraperitoneal insufflation with carbon dioxide, while no changes were observed when nitrous oxide was used. The clinical consequences of these findings are discussed.

Acid-Base Equilibrium↗
PubMed1976

[Prevention of tracheal lesions by rhythmic insufflation of the intubation catheter ballone].

The prevention of tracheal lesions due to the ballons of the intubation catheters depends on the correction of several factors concerning: -the material used (polyvinyl is better tolerated than rubber); -the shape (the sleeve-shape balloons are less traumatic); -the pressure of use, which should remain moderate; -the permanence of the compression (one should use intermittent filling of the ballon). A device designed by the authors and which is described here, permits intermittent insufflation of the ballons of the endotracheal catheters, by adaptation of certain apparatus of artificial ventilation, type LOGIC and SF4, has given excellent results.

Humans↗
PubMed1976

Haemodynamic effects produced by insufflation of carbon dioxide into the abdominal cavity during laparoscopy.

Nine healthy women underwent diagnostic laparoscopy during balanced anaesthesia without halothane. Heart rate, blood pressure and cardiac output were measured before and after insufflation of carbon dioxide in to the abdominal cavity. The cardiac output was measured by a bedside radiocardiographic apparatus using 113Indium as a tracer. There was remarkable stability of the cardiovascular system during laparoscopy with only slight rise in blood pressure.

Abdomen↗
PubMed1977

Physiologic evaluation of the HFPPV pneumatic valve principle and PEEP. An experimental study.

In experiments in dogs the ventilatory and circulatory conditions prevailing with the ventilatory pattern in high-frequency positive-pressure ventilation (HFPPV) were investigated with use of a pneumatic valve principle and a ventilator system of an "open" character. Keeping the gas input constant the importance of insufflation frequency and insufflation time and the reactions to various levels of positive end-expiratory pressure (PEEP) were investigated in terms of changes in arterial pH, Pco2 and Po2. With the volumes of delivered gas kept constant, an increasing insufflation frequency from 60 to 100 per min gave a parallel decrease in tidal volume accompanied by lower maximum intratracheal pressures and a significant decrease in alveolar ventilation. Also taking into account the possibilities of inducing a suppression of the spontaneous respiration, higher ventilatory frequencies than 60 per min do now seem to introduce any further advantages. Including the associated effects on cardiac output and venous admixture, the cardio-pulmonary and circulatory parameters studied did not show any substantial changes with PEEP levels below 7.5--10 cm H2O. Thus the level of PEEP, which often is part of the ventilatory pattern in HFPPV, does not seem to have any untoward influence on the circulation (stroke volume, cardiac output, total peripheral vascular resistance) and oxygen transport (arterial oxygen content and oxygen flux) in normovolaemic dogs.

Animals↗
PubMed1975

[Evaluation of the pneumomediastinum for the diagnosis of tumours in the anterior mediastinum(author's transl)].

Using a correct retrosternal technique, adequate insufflation of negative contrast material and good radiography, a pneumo-mediastinum is the method of choice for the investigation of retrosternal tumours with respect to their position, size and shape. By means of experiments on cadavers, a suitable needle was developed. The method of air insufflation and radiographic positioning are described. The results of our examinations are detailed and the method is discussed.

Adult↗
PubMed1978

Luteinising hormone-releasing hormone nasal spray as therapy for undescended testicle.

Twenty-two prepubertal children with unilateral cryptorchidism were treated. None had undergone previous medical or surgical to modify the abnormal position of the testes, all of which were located inthe inguinal canal. Treatment was with luteinising hormone-releasing hormone (LH-RH) nasal spray given for 7 days. 9 boys insufflated 100 microgram LH-RH in each nostril 6 times per 24 hours (1200 microgram/24 h); the remaining 13 boys insufflated 500 microgram 12-hourly (1000 microgram/24 h). An LH-RH test (500 microgram IV) was carried out before and after therapy. Full descent of the testis into the scrotum was obtained in 7 out of the 22 cases; in a further 6 cases the testis moved down the inguinal canal. Basal values of luteinising hormone and follicle-stimulating hormone and those for pituitary reserve remained unchanged before and after therapy, and were similar to the values of a control group. No correlation was found between response to therapy and bone age, testosterone level in serum, basal values or pituitary reserve of luteinising hormone or follicle-stimulating hormone.

Administration, Intranasal↗
PubMed1976

Experience with the use of the Carboflator for establishing pneumoperitoneum.

Safe and adequate pneumoperitoneum is dependent upon intraperitoneal pressure and not upon the number of liters of gas insufflated. Volume of gas delivered depends upon the size of the patient and whether there is any possible leakage. The Carboflator is a useful instrument for establishing controlled insufflation of gas and fail-safe intraperitoneal pressure.

Laparoscopes↗
PubMed1975

[Important physiological considerations in artificial respiration and reanimation of newborn infants].

The methods used for ventilation of the neonate shold be based upon consideration of the physiological changes which occure in the lungs and circulation at birth of the normal infant. Three important changes must be taken into consideration. The first is the formation of a residual volume of alveolar gas, the second the resorption of pulmonary fluid and the third a decrease in pulmonary vascular resistance, upon which is dependent the change from foetal circulation to that of the neonate. To begin insufflation of foetal lungs it is necessary to use a pressure of between 20 and 30 cm H2O. After the first insufflation, a good deal of air remains in the lungs, even during expiration, as long as pulmonary "surfactant" is present. In the absence of the latter, residual pressure at the end of expiration is necessary in order to avoid the lung emptying itself of air. The resorption of pulmonary liquid from the alveolar spaces into the blood is dependent upon a change in the permeability of the alveolar epithelium, which renders possible the rapid passage of water via the channels which open, probably between the epithelial cells, and this change is dependent upon an expansion of the lungs by a pressure of between 35 and 40 cm H2O. Dilatation of the pulmonary vessels depends in part upon an increase in partial pressure of oxygen and a fall in carbon dioxide in the environment of the pulmonary arterioles, and in part upon mechanical changes brought about by the movements of ventilatation.

Humans↗
PubMed1978

[Necessity to control endexpiratory CO2-concentration during laparoscopic sterilisation under general anaesthesia with controlled ventilation (author's transl)].

During laparoscopy and intraabdominal insufflation of CO2 cardio-respiratory accidents following increased PaCO2 are possible. The continuous measurement of endexpiratory CO2-concentration by infrared absorption spectrometry is a simple method for controlling the level of ventilation. Respiratory acidosis under controlled artificial ventilation during laparoscopy can thus be avoided.

Acidosis, Respiratory↗
PubMed1976

A new technique and instruments for delivery of the Fallopian tube in female sterilization.

This report describes an instrument designed for locating and delivering the Fallopian tube through an incision of less than 2 cm. Since no gas insufflation, fibre optic illumination, or electricity is required for successful use of this instrument, it is well suited for performing outpatient tubal sterilizations in areas where other methods, such as laparoscopic procedures, are not feasible.

Female↗
PubMed1977

Congenital lobar emphysema.

Congenital lobar emphysema is reported occurring in a 10 day old, low birth weight infant. Following resection, gross examination of the affected lobe revealed collapsed but unobstructed bronchi, suggesting a cartilaginous defect. The specimen was insufflated with formalin and the bronchial tree dissected out. Histological study including comparison with a normal pulmonary lobe, confirms that abnormalities of cartilage may be important in the pathogenesis of congenital lobar emphysema.

Cartilage↗
PubMed1977

Prostaglandin release by slow reacting substance from guinea pig and human lung tissue.

Slow reacting substance (SRS) injected into the pulmonary artery released prostaglandins E (PGE) and F2alpha (PGF2alpha) and the 15-keto-13, 14-dihydro PG metabolites from non-sensitized and ovalbumin sensitized, isolated, perfused guinea pig lungs. PGs were also released from lungs incubated with SRS. Sensitized lungs released more PGs in both types of preparations. Indomethacin inhibited the effect of SRS. Passively sensitized human lung fragments, in parallel to guinea pig lung, released PGE, PGF2alpha and the metabolites when incubated with SRS or antigen. In in vivo experiments, SRS and arachidonic acid given intravenously increased the airway insufflation pressure in anesthetized quinea pigs. These effects, but not the action of injected PGF2alpha and histamine, were abolished by indomethacin. The results indicate that one of the modes of SRS action is by release of PGs, and are consistent with the hypothesis that PGs are predominantly "secondary" mediators (in the temporal sense) of the antigen-antibody reaction.

Airway Resistance↗
PubMed1976

Disodium cromoglycate in ragweed-allergic rhinitis.

This study was designed to test the effectiveness of disodium cromoglycate when compared to placebo in a double-blind study in patients with ragweed allergic rhinitis. Patients were selected on the basis of a clinical history and a 4+ reaction to the intradermal injection of water-soluble ragweed, 0.02 c.c. of 500 PNU/c.c. Active agent/placebo groups were selected at random and were on the drug for approximately 8 wk, commencing 1 wk prior to the onset of the ragweed pollen season. Patient response was evaluated using patient diary cards, number of antihistamine tablets taken, and patient interviews. In the Toronto study, of 17 patients on the active drug, 15 were graded as improved, compared to only 6 of 21 placebo-treated patients who were improved. However, in the Hamilton study, results were less impressive. Nonetheless, it appears that intranasal insufflation of disodium cromoglycate was more effective in reducing ragweed hay fever symptoms than placebo.

Clinical Trials as Topic↗
PubMed1977

Mesenteric hematoma--meckel's diverticulum: a rare laparoscopic complication.

As previously reported, most complications of laparoscopy occur during the induction of pneumoperitoneum. In addition to the known complications of emphysema, embolism, and pneumocolon, the insufflating needle may occasionally cause bleeding by entering inadvertently into a vessel which may in rare situations be a mesenteric artery. Luckily, this complication is rare enough not to necessitate typing, cross-matching, and preparation of blood for every laparoscopic procedure. Injury to the iliac mesentery, with mesenteric artery perforation and a resulting hematoma, occurred during laparoscopy for tubal sterilization. This report describes the operative finding of a Meckel's cord attaching the ileum to the umbilicus, leading to this unusual and serious complication necessitating an immediate laparotomy and ileal resection.

Adult↗