Two-lung and one-lung ventilation in patients with chronic obstructive pulmonary disease: the effects of position and F(IO)2.

Unlabelled: We compared the effects of position and fraction of inspired oxygen (F(IO)2) on oxygenation during thoracic surgery in 24 consenting patients randomly assigned to receive an F(IO)2 of 0.4 (eight patients, Group 0.4), 0.

Respiratory mechanics and gas exchange during one-lung ventilation for thoracic surgery: the effects of end-inspiratory pause in stable COPD patients.

Objective: To examine the effects of end-inspiratory pause (EIP) of different durations on pulmonary mechanics and gas exchange during one-lung ventilation (OLV) for thoracic surgery.

Design: A prospective clinical study.

Setting: A university hospital.

Interrupted expiratory flow on automatically constructed flow-volume curves may determine the presence of intrinsic positive end-expiratory pressure during one-lung ventilation.

Unlabelled: We studied patients undergoing elective pulmonary surgery to establish whether observing interrupted expiratory flow (IEF) on the flow-volume curves constructed by the Ultima SV respiratory monitor is a reliable way to identify patients with dynamic pulmonary hyperinflation and intrinsic positive end-expiratory pressure (PEEPi). Patients' tracheas were intubated with a double-lumen endotracheal tube and ventilated with a Siemens 900C constant flow ventilator. In 30 patients, PEEPi was determined by the end-expiratory occlusion (EEO) method during the periods of two-lung and one-lung ventilation in the lateral position.

Airway pressure changes during one-lung ventilation.

This investigation analyzed the changes in inspiratory airway pressures during transition from two-lung to one-lung ventilation in patients tracheally intubated with a double-lumen endotracheal tube (DLT) using a classical method of intubation without fiberoptic bronchoscopy. All patients were anesthetized in a standardized fashion. Ventilation was accomplished with the Siemens 900 constant-flow mechanical ventilator (Solna, Sweden).

Intrinsic positive end-expiratory pressure during one-lung ventilation for thoracic surgery. The influence of preoperative pulmonary function.

Objective: To detect and to quantify intrinsic positive end-expiratory pressure (PEEPi) during thoracic surgery in the dependent lung of patients intubated with a double-lumen endotracheal tube (DLT) in the lateral position.

Methods: Twenty consecutive patients undergoing elective pulmonary resection were anesthetized, paralyzed, and intubated with a DLT. Their lungs were ventilated (Siemens Servo 900 C ventilator; Siemens Elevna; Solna, Sweden) with constant inspiratory flow.

Large tidal volume ventilation does not improve oxygenation in morbidly obese patients during anesthesia.

Eight morbidly obese patients (body mass index [BMI] = 46) were studied during general anesthesia and controlled mechanical ventilation. To evaluate the effect of large tidal volume ventilation on oxygenation and ventilation, the baseline 13 mL/kg tidal volume (VT) (calculated by the ideal body weight) was increased in 3 mL/kg volume increments to 22 mL/kg, while ventilatory rate (RR) and inspiratory time (TI) were kept constant. Each volume increment was maintained for 15 min.

On-line expiratory flow-volume curves during thoracic surgery: occurrence of auto-PEEP.

Flow-volume loops were monitored continuously in 39 patients undergoing thoracic surgery requiring one-lung ventilation. In 26 of the 39 patients (67%), auto-positive end-expiratory pressure (auto-PEEP) was seen on the flow-volume curves during both two-lung and one-lung ventilation. Eighty-seven percent of the patients whose trachea was intubated with a smaller size (35- and 37-French gauge) double-lumen tracheal tube exhibited auto-PEEP, compared with patients in whom the tube used was larger (39- or 41-French gauge: 54% and 50%, respectively).

Continuous spirometry: an aid to monitoring ventilation during operation.

We present six case-reports of patients who experienced inadequate ventilation as a result of endobronchial or oesophageal intubation, or obstruction to the tracheal tube or airway and were monitored with on-line spirometry. The continuously displayed pressure-volume or flow-volume loops may be compared with previously recorded baseline loops. The changing configuration of the curves offers additional and instantaneous information about the cause of increased inspiratory airway pressure, decreased compliance or increased airway resistance.

Continuous spirometry for detection of double-lumen endobronchial tube displacement.

Flow-volume and pressure-volume loops were measured with continuous spirometry in 49 patients in whom the trachea was intubated "blindly" with a double-lumen endobronchial tube for thoracic surgery. Nineteen endobronchial tubes were malpositioned by fibreoptic bronchoscopic criteria; 63% of these were suspected because of the configuration of the spirometric loops. During positioning of the patient and during operation, 34.

Ventilatory effects of pneumoperitoneum monitored with continuous spirometry.

Inspiratory and expiratory tidal volume, peak and plateau airway pressure, compliance of the respiratory system, pressure-volume and flow-volume loops were monitored continuously and recorded in seven women undergoing laparoscopy with carbon dioxide insufflation to an intra-abdominal pressure of 1.6 kPa. All patients were anaesthetised using a total intravenous technique and a constant minute ventilation was maintained.

Continuous noninvasive blood pressure monitoring during thoracic surgery.

To evaluate the usefulness of noninvasive blood pressure monitoring during thoracic surgery, blood pressure measurements obtained with the Finapres 2300 (Ohmeda, Boulder, CO) were compared with an intraarterial catheter system in 10 patients undergoing thoracotomy for lobectomy or pneumonectomy. The Finapres measurements were compared with pressure data obtained ipsilaterally from a radial artery catheter-transducer system. The waveforms were recorded using a strip chart recorder; the systolic (SBP) and diastolic blood pressures (DBP) were measured every 20 seconds on the paper trace.

Prilocaine-induced methemoglobinemia evidenced by pulse oximetry.

Methemoglobinemia was suspected in a healthy 19-year-old woman, when the pulse oximeter reading (SpO2) was 88% after a plexus brachialis block with 550 mg (35 ml, 1.5%) prilocaine. The patient was receiving 50% oxygen, and the PaO2 was 48.

Spinal bupivacain anaesthesia in traumatological surgery.

Two-hundred forty spinal cases of bupivacain anaesthesia are reported. One third of the patients was over 60 years of age and one quarter in a poor condition. No serious or lasting complications were observed.