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By way of introduction the authors deal with the necessity for suction as an important component of ergonomic work organization in dental practice. The technical pre-conditions (suction technique) are indicated. Principles are formulated for their beneficial application in the sense of systematic suction methodics.
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In an anesthetized hypoxemic animal model, 15 seconds of endotracheal suctioning, using a suction pressure of --170 mm. Hg and endotracheal tube to suction catheter ratio of 1.87 to 1, produced a 13 mm. Hg fall in arterial oxygen tension. Oxygen tension did not return to control level even at 5 minutes after suctioning. Giving 100 per cent oxygen before suctioning prevented suction-induced hypoxemia during and immediately after suctioning, but at 5 minutes after suctioning, oxygen tension fell below control levels. Mechanical lung hyperinflation with room air after suctioning quickly raised arterial oxygen tension above control levels. When mechanical ventilation using 100 per cent oxygen was maintained before, during, and after the suction procedure, arterial oxygen tension remained elevated at all times.
The continuous recordings of arterial oxygen saturation (SaO2) and beat-to-beat heart rate before, during, and after tracheobronchial suctioning were studied in eight preterm infants with severe RDS receiving mechanical ventilation. Two suctioning procedures were alternatively performed in each infant; In procedure A, disconnection of the ventilator and preoxygenation preceded suctioning; in procedure B, a special suction adaptor was used without ventilatory interruption or preoxygenation; 128 suctionings were performed with each procedure and the changes in heart rate (HR) and SaO2 during suctioning were compared. Although in both procedures, HR and SaO2 decreased during suctioning, the degree of bradycardia and arterial blood oxygen desaturation were significantly smaller in magnitude and shorter in duration during procedure B. These data indicate advantages of the suction adaptor in minimizing bradycardia and hypoxia from airway suction.
The suctioning efficiency and trauma-producing characteristics of five commercially available tracheobronchial suction catheters (Pharmaseal Tri-Flo, NCC Gentle-Flo, Argyle Aero-Flo, Argyle Dual Side-Hole, and Pharmaseal Whistle-Tip) were experimentally evaluated in anesthetized healthy dogs. The tendency of catheters to invaginate or "grab" tracheobronchial mucosa was observed with a bronchofiberscope during suctioning. Mucosal grabbing was seldom seen even at high (greater than 300 torr) vacuum levels with the cateter tip in the trachea. All catheters were observed to invaginate mucosa in lobar and segmental bronchi, with the frequency of grabbing being a function of airway anatomy, airway size, catheter orientation, tip design, and vacuum level. Catheters with multiple side-holes appeared to invaginate mucosa less frequently than the single side-hole catheter. Repeated suctioning of anesthetized healthy dogs followed by tracheobronchial excision, gross observation, and histologic examination of mucosal tissue biopsies demonstrated significant differences in the frequency and severity of lesions caused by the tracheobronchial suction procedure. All catheters were observed to damage airway lining, the damage related to multiple side-hole catheters appearing to be associated entirely with the act of cateter insertion and not with the application of vacuum. Only the Whistle-Tip design produced measurable damage beyond that related to catheter insertion. The average tip-suctioning effectiveness for each catheter, determined in vitro by aspirating a thin, uniform layer of simulated mucus, was found to be significantly higher for the Tri-Flo and Whistle-Tip catheters than the others, the Aero-Flo being least effective. Preliminary attempts to demonstrate this difference in suctioning effectiveness by comparing the performance of the catheters which displayed the highest and lowest tip suction effectiveness in a standardized clinical suctioning procedure revealed no significant difference in the percentage of mucus removed by either catheter. Additional studies should clarify this apparent contradiction.
Fifty-eight patients with mild to moderately severe acute pancreatitis were randomly allocated to treatment with or without nasogastric suction (27 and 31 patients respectively). Intravenous fluids and pethidine hydrochloride were also given. The two groups were comparable clinically at the start of the study. There were no differences between the two groups in the mean duration of the following features: abdominal pain or tenderness; absence of bowel movements; raised serum amylase concentration; time to resumption of oral feeding; and days in hospital. Prolonged hyperamylasaemia (serum amylase greater than 0.33 mU/l) occurred in one patient in the suction group and in three patients in the non-suction group. A mild recurrence of abdominal pain after resumption of oral feeding occurred in three patients in the suction group and in two patients in the non-suction group. Two patients in the suction group developed overt consumption coagulopathy and two others pulmonary complications. No patient in the non-suction group had complications. The findings suggest that most patients with mild to moderately severe acute pancreatitis do not benefit from nasogastric suction. The procedure should be elective rather than mandatory in treating this condition.
In the field of emergency medicine there has been a need for an efficient suction pump that can be used under all types of conditions and included both in doctors' emergency kits as well as in the standard equipment of mobile units such as ambulance cars, helicopters etc. The devices available in the past had decided disadvantages in their construction and performance. A newly designed suction pump -- the AMBU Uni-Suction -- has been subjected to laboratory and practical tests concerning function, material and practical use, based on a specification of requirements for such a device. The results show that this universally applicable suction pump meets every requirement under the different test conditions. The effectiveness is good, irrespective of the mode of operation applied, i.e. by hand, by foot or by compressed gases. Maintenance and service are negligible and no susceptibility to malfunction was observed. In addition, the design, function and performance of an accessory unit, the Suction Booster, are presented. This device can be used effectively in combination with the new suction pump, or with any other type of suction unit to prevent dangerous aspiration in emergencies.
All curettages of a 8-week-period were done using the suction system of Hamann and Pockrandt. This test-collective includes 66 patients, their age was between 20 and 78 years; 6 of them had to be excluded: the surgical intervention was begun without general anaesthesia but continued with general anaesthesia is required by the patient. The test-collective was divided into 2 groups: in group A (30 patients) all suction-curettages were done in general anaesthesia, in the first 20 patients a conventional curettage with dilation of the cervix were performed additionally, in order to proof the effectiveness of the suction curettage. The histological findings of the materials of the conventional curettages had shown no more informations than that of the materials of the suction curettages. -- In group B (30 patients) the suction curettage were done in diazepampentazocin-analgesia; a third of them had specified no sensations, the others had stated a feeling of pressure or spasms. -- In each group the histological examinations were possible without any problems. The advantages of the suction curettage system are the rare necessity of cervix dilatation (7 of 60 cases), the possibility of the operation without general anaesthesia and the possibility of a quick performance of the curettage.
The incidence and character of the bacteremia associated with elective suction abortion was investigated in volunteer subjects aged 19 to 35 years who were to undergo first trimester abortion by suction curettage. One hundred and forty-four blood cultures were obtained from thirteen pregnant and four non-pregnant (control) subjects matched for age. Transient bacteremia occurred during or soon after suction abortion in 11 of 13 (84.7%) study subjects. Four of these patients were bacteremic after bimanual pelvic examination, just prior to initiation of the abortion procedure. Seven others developed bacteremia temporally related to cervical dilatation and suction abortion. The bacteremia was intermittent in some, persistent in others, existed as long as one hour after the procedure, and was transient in all patients. Microorganisms isolated from the blood were all normal genital tract flora and were predominantly anaerobes, although alpha hemolytic streptococci were also recovered. Mixed bacteremia occurred in six patients. In contrast, blood cultures from four non-pregnant women were sterile. This study indicates that the systemic circulation-uterine cavity barrier is significantly disrupted during abortion by suction curettage permitting endogenous genital tract microorganisms to gain access into the bloodstream. These observations also suggest that there may be some risk of developing endocarditis during suction abortion in patients with cardiac deformities, and lend some support to the current practice of giving antibiotic prophylaxis to abortion patients with cardiac lesions which predispose them to endocarditis.
The cardiovascular responses to tracheal suction were observed in 4 consecutive recently-injured tetraplegics with physiologically complete cervical spinal cord transections (C3-5) who were in spinal shock and needed artificial ventilation. In all 4 patients tracheal suction induced bradycardia and in 2 patients even cardiac arrest. The bradycardia occurred when the patients were hypoxic, and was prevented by the addition of oxygen to inspired air, or, if this was inadequate, by the administration of atropine. Two of the patients were agains studied several months later, after return of isolated spinal cord activity and spontaneous breathing. In both patients tracheal suction then caused tachycardia and increased respiratory effort. It is concluded that: 1. Tetraplegics with high cervical spinal cord transections who are in spinal shock and unable to breathe spontaneously are prone to bradycardia and cardiac arrest during tracheal suction. This is more likely to occur when they are hypoxic. 2. The bradycardia appears to be due to a vago-vagal reflex for both afferent and efferent limbs of the arc are in the vagus nerve. A number of factors play a part, including (I) absent sympathetic activity; (II) airway receptor stimulation; (III) hypoxia and (IV) the inability to breathe spontaneously (The pulmonary (inflation) vagal reflex which would normally oppose the cardio-inhibition caused by (II) and (III) is absent). 3. The bradycardia in response to tracheal suction can be prevented by adequate oxygenation, or if this cannot be achieved, by repeated atropine.
A comparative study was made between 60 patients in whom drainage of subhepatic space was performed after uncomplicated cholecystectomy and 60 patients in whom no drainage was performed. In addition, 30 patients were treated without drainage, nasogastric suction, or intravenous fluids. After operation the patients were evaluated as to postoperative pyrexia, wound infection, lung atelectasis, thrombophlebitis, and postoperative stay in hospital. Fever and wound infection occurred in fewer patients without drainage than those with drainage, but omission of nasogastric suction and intravenous fluids did not influence the incidence of wound infection. Postoperative stay in hospital was shorter in the patients without drainage and shortest in those treated without drainage, nasogastric suction, and intravenous fluids. Nasogastric suction and intravenous fluids are not needed postoperatively, as the degree of the paralytic ileus is very slight and they may be harmful, causing lung atelectasis and thrombophlebitis. Uncomplicated cholecystectomy may be performed safely without drainage, postoperative nasogastric suction, and intravenous fluids.
In patients treated with ventilation therapy only 60% of blind suction catheters reach the desired position. In ten patients the routinely performed blind suction was replaced by aimed bronchoscopic suction. Blood gas analyses before and after aimed and blind suction favoured the former. Also the arterioalveolar oxygen tension difference showed a good response to aimed suction. There is a broad spectrum of indications for fibreoptic bronchoscopy in every care unit dealing with mechanical ventilation.
Vitreous suction is still a useful procedure in cases of severe vitreous opacification. In spite of the technical perfection and good results of vitrectomy, the chances of a vitreous suction should be taken into consideration before a definite decision is made. The surgical technique of vitreous suction is very simple, lensectomy is never required, and the possibility of a subsequent vitrectomy is not impaired of the suction manoeuvre has failed. The frequency of complications, namely retinal detachment and bacterial intraocular infection, is reasonable if the almost hopeless condition of the affected eyes, and the severe general diabetic angiopathy and poor resistance are considered, which in individuals with postoperative endophthalmitis usually are found. Vitreous suction is still acceptable as a minor sort of vitrectomy.
Key innovations open ecological opportunities and can redirect evolutionary trajectories. In spiny-finned fishes, the pelvic suction cup-a fused adhesive structure formed from the pelvic fins and supported by a modified girdle-appears to be one such trait. Using a novel 960-species phylogeny spanning 940 exons and 67 newly sequenced snailfish genomes, we show that the suction cup evolved independently three times across lineages separated by over 100 million years. By enabling adhesion in high-energy habitats such as tide pools and waterfalls, the suction cup set the stage for body depression and accompanying shifts in scales, teeth, and clade-specific ecofunctional profiles. Comparative analyses reveal convergence in a distinctive region of morphospace and body-shape evolution accelerated two- to fivefold. Diversification analyses uncover heterogeneous but elevated rates, with a clear burst in rock-climbing gobies associated with suction cup evolution. By opening novel habitats and fostering phenotypic novelty, the suction cup emerges as a key innovation that reshaped spiny-finned fish evolution.
A suction booster is described which may be interposed between the endotracheal tube and the main suction system. This allows suction to be instantly ready throughout the intubation procedure, the rate of suction to be increased up to ten-fold, and all solid particles which can pass through the tracheal tube to be removed without the risk of blockage.
The Stocks suction bullet is a device allowing maintenance of positive pressure ventilation, continuous distending pressure and high inspired oxygen concentrations during tracheal toilet in intubated patients. The effectiveness of this device was studied using an experimental apparatus and a dummy lung to represent neonates being treated with either C.P.A.P. or I.P.P.V. and P.E.E.P. By using appropriate combinations of suction catheter type and size, bullet lumen size, ventilator settings and suction pressure limit, it was possible to maintain during suctioning ventilation peak pressures between 50% and 100% of presuction levels and continuous distending pressures (P.E.E.P. or C.P.A.P.) at or in excess of 80% of presuction levels.
A peristaltic pump (type "Perpex", J. H. Guldener, Zürich, Switzerland) was modified for controlled aspiration in vitrectomy (fig. 1). The surgeon operates start, instantaneous stop and back flush with a single foot pedal. Suction and cutting device are controlled independently. Suction flow can continuously be varied between 0 and 16 ml/min (fig. 2). This less critical function is operated by the assistent. The upper limit of suction flow depends on infusion resistance and preselected differential pressure (fig. 3). The infusion resistance and its reciprocal, the inflow rate, vary considerably with different instruments. In four devices infusion resistance was measured and found to vary by a factor of up to 4.6. Low infusion resistance allows high suction flow and thus shorter operation time for certain conditions such as "ochre membranes" or intrasurgical bleedings. Further aids which we use in combination with a Zeiss OPMI-8 are an intense external xenon light source for variable slit illumination which makes the use of intravitreal fiber optics unnecessary, and a mirror combination to achieve an 11 degrees semi-coaxial stereoscopic view of the operation field for the assistent.