Showing papers on "Hypoventilation published in 1968"

Radio-Frequency Electrophrenic Respiration: Long-Term Application to a Patient With Primary Hypoventilation

Abstract: Radio-frequency electrophrenic respiration (EPR) has been used successfully on a long-term intermittent basis to manage a patient with primary hypoventilation. The ability to use it only when desired, to adjust the amplitude of stimulation, and to control the rate of stimulation externally, has been made possible by use of the technique of radio-frequency transmission. Electrophrenic respiration by stimulation of one phrenic nerve has been carried out each night for ten months. Moderate fatigue of the stimulated diaghragm could be demonstrated after ten hours of stimulation. Further observation is required to determine if such fatigue is progressive. The future uses of radio-frequency electrophrenic respiration may include any condition of hypoventilation associated with an intact phrenic nerve and diaphragm. Whether its use will be of long-term benefit in the early stages of some hypoventilatory situations secondary to parenchymal disease is under study.

Regional lung function in patients with bronchial asthma

Abstract: The regional distribution of pulmonary ventilation and perfusion and regional alveolar ventilation/perfusion ratios were measured with radioactive xenon (133xenon) in 10 patients with asthma in remission. Four subjects had normal ventilation distribution, four had hypoventilation in some regions and normal ventilation in others, and two patients had abnormal ventilation in almost all lung regions. The lung bases were involved most frequently and the middle zones least frequently. Correlation was good between the degree of over-all ventilatory impairment calculated from 133xenon values and measurement of the maximal midexpiratory flow rate the same day. Regions which were hypoventilated had low ventilation/perfusion ratios and also tended to be hypoperfused. In the eight subjects who had been studied similarly 5 yr previously, changes in regional function correlated in general with changes in over-all function.

Effect of bronchoscopy with premedication and topical anesthesia on arterial blood gases.

Abstract: IT IS well recognized that the perfect anesthesia for bronchoscopy has yet to be found. 1 Recently general anesthesia has gained popularity for endoscopic procedures. A number of techniques to overcome the hypoventilation associated with the administration of a general anesthetic have been reported. 2-5 Normal arterial oxygen saturation and adequate carbon dioxide removal during bronchoscopy have been considered by some to be one of the advantages of general anesthesia with assisted ventilation. It is our impression that topical anesthesia has several advantages, not the least of which is the ability to perform the examination without depending on assisted ventilation. Failure to provide adequate ventilation and prevent respiratory acidosis may predispose the patient to cardiac arrest, especially since many of the patients who require bronchoscopic examination have pulmonary insufficiency and chronic respiratory acidosis. In order to investigate the effect of topical anesthesia and bronchoscopy on the arterial oxygen pressure (P

Respiratory stimulant action of morphine in man

Abstract: An intravenous dose of 10 mg morphine sulphate per 70 kg was found to cause immediate respiratory stimulation in two of eight normal men. In one of the two, respiratory depression followed within 15 minutes; in the other a degree of hyperventilation was still present after 2 hours, despite irregularity of breathing similar to that which accompanied hypoventilation in the other subjects.

Prevention and therapy of respiratory anesthetic complications

Abstract: In USA the operation mortality-rate of anesthesia is 10%, and 90% of this is avoidable, while in Germany statistically conclusive figures are still missing. The anesthetic dead-cases are nearly all caused by respiratory or cardiovascular complications; the respiratory complications are prevailing. In the first line there is aspiration with 30% of all dead-cases. The shock follows with 25%, the respiratory failure with 15%, cardiac arrest with 15% and other causes with 15%. A critical analysis of the dead-cases in connection with their origin mechanism results in 4 groups: The respiratory complications, either directly or with hypoventilation, lead to asphixia, to a serious depression of the medulla oblongata, of the myocard and the peripheral circulation. Consequently the result is a cardiovascular collapse, cardiac arrest or ventricular fibrillation. To avoid respiratory insufficiency it is necessary to keep the airways free and to oxygenate sufficiently. The endotracheal intubation only is a secure protection against aspiration and obstruction of the upper airways. Patients with full stomach that undergo a live saving operation are intubated after a stomach-tube is put in and after suction, while the patients upper part of the trunk is kept in elevated position and he is anesthetised. For premedication only atropin is given. During anesthesia only patients in dorsal position that undergo plastic surgery or surgery of their extremities breathe spontaneously. If the operation takes more than half an hour assisted respiration is applied. During operations of the stomach, thorax and intracranial surgery controlled respiration is used. Postoperatively the tidal volume at least should be 5 ml/kg and the patient must be awake. Otherwise: prolonged intubation. With previous lung-diseases, that restrict the respiratory reserves about more than 30%, assisted ventilation is applied for more than 6–12 hours. Patients with extracorporal circulation for more than 30 minutes, every two cave or bilateral operation, every oesophagus resection and surgical complication are intubated and artificially ventilated.

Tracheostomy in acute respiratory failure: effects assessed by arterial blood gases

Abstract: The effects of tracheostomy in 27 patients with severe respiratory difficulty are described in terms of arterial blood gas values and clinical observations. Postoperatively, mouth breathing was compared with tracheostomy breathing. Obstruction of the lower respiratory tract from accumulated secretions leads to hypoventilation, ineffective coughing, carbon dioxide retention, anoxia and coma. In such cases, tracheostomy may be life-saving because it provides a reliable pathway: a) for suctioning the secretions (which may be unusually abundant in emphysema with bronchitis), and b) for the administration of artificial respiration. An important factor in the outcome of tracheostomy is meticulous postoperative care. Attention to such things as proper tube alignment and proper suctioning techniques goes a long way toward preventing possible mucosal damage and infection. Tracheostomy provides therapeutic relief even to patients who are gravely ill (narcosis, coma) with emphysema and bronchitis.