Dead space ventilation promotes alveolar hypocapnia reducing surfactant secretion by altering mitochondrial function.

Background: In acute respiratory distress syndrome (ARDS), pulmonary perfusion failure increases physiologic dead space ventilation (V/V), leading to a decline of the alveolar CO concentration [CO]. Although it has been shown that alveolar hypocapnia contributes to formation of atelectasis and surfactant depletion, a typical complication in ARDS, the underlying mechanism has not been elucidated so far.

Methods: In isolated perfused rat lungs, cytosolic or mitochondrial Ca concentrations ([Ca] or [Ca], respectively) of alveolar epithelial cells (AECs), surfactant secretion and the projected area of alveoli were quantified by real-time fluorescence or bright-field imaging (n=3-7 per group).

Prehospital non-invasive ventilation in acute respiratory failure is justified even if the distance to hospital is short.

Aims: Evaluation of the efficacy of prehospital non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema (CPE).

Material And Methods: Consecutive patients who were prehospitally treated by Emergency Physicians using NIV were prospectively included. A step-by-step approach escalating NIV-application from continuous positive airway pressure (CPAP) to continuous positive airway pressure supplemented by pressure support (CPAP-ASB) and finally bilevel inspiratory positive airway pressure (BIPAP) was used.

IDH3 mediates apoptosis of alveolar epithelial cells type 2 due to mitochondrial Ca uptake during hypocapnia.

In adult respiratory distress syndrome (ARDS) pulmonary perfusion failure increases physiologic dead-space (V/V) correlating with mortality. High V/V results in alveolar hypocapnia, which has been demonstrated to cause edema formation, atelectasis, and surfactant depletion, evoked, at least in part, by apoptosis of alveolar epithelial cells (AEC). However, the mechanism underlying the hypocapnia-induced AEC apoptosis is unknown.

Sedation for advanced procedures in the bronchoscopy suite: proceduralist or anesthesiologist?

Purpose Of Review: This article focuses on the issue of sedation provided either by proceduralists or anesthesiologists for advanced bronchoscopy procedures. The relative merits of both approaches are presented. Current evidence from the literature and guideline recommendations relevant to this topic are reviewed.

Perioperative fluid therapy: defining a clinical algorithm between insufficient and excessive.

In the perioperative scenario, adequate fluid and volume therapy is a challenging task. Despite improved knowledge on the physiology of the vascular barrier function and its respective pathophysiologic disturbances during the perioperative process, clear-cut therapeutic principles are difficult to implement. Neglecting the physiologic basis of the vascular barrier and the cardiovascular system, numerous studies proclaiming different approaches to fluid and volume therapy do not provide a rationale, as various surgical and patient risk groups, and different fluid regimens combined with varying hemodynamic measures and variable algorithms led to conflicting results.

[Drowning - An update on prehospital and intrahospital treatment strategies].

500000 people die from unintentional drowning each year worldwide. Drowning accidents occur to humans of every age, while fatal drowning is the leading cause of death among boys 5 to 14 years of age. In Germany, however, most drowning victims are elderly people.

[Anesthesia in interventional pulmonology -- endoscopic interventions: part 2].

Endobronchial ultrasound-guided transbronchial needle aspiration can be used efficiently for pathological diagnosis of bronchial walls and surrounding structures. Patients with hemoptysis, fistulas or foreign-body-aspiration can be treated bronchoscopically, but remain a challenge for the hospital team involved.

[Anesthesiology in interventional pneumology- endoscopic interventions: part 1].

Less invasive bronchoscopic techniques for lung-volume-reduction have almost replaced surgical resections. Tracheobronchial obstructions and - to a certain degree - even bronchial tumors can be treated bronchoscopically. However all these procedures show specific risks anesthesiologists have to consider.

[Anesthesia in interventional pulmonology -- bronchoscopy and jet ventilation].

Today interventional procedures are frequently used for diagnosis and treatment in patients with various pulmonary diseases. Besides bronchoscopy in local- or general anesthesia jet-ventilation is commonly applied via catheter or rigid bronchoscope. Anesthesiologists should have profound knowledge of high-frequency ventilation and possible complications when assisting during interventional procedures.

[Anaesthesia for extrathoracal vascular surgery - Part 2: anaesthesiological management].

The anaesthesiological management in patients undergoing vascular surgical procedure need an individual approach, because of the high incidence of coexisting diseases with an increased risk of cardiovascular complications. The choice of anaesthesiogical method und perioperative monitoring depends on planned vascular procedures.

[Anaesthesia for extrathoracal vascular surgical procedures - part 1: optimization on the preoperative therapy].

Vascular surgical patients have an increased perioperative risk for cardiovascular complications because of high incidence of cardiovascular risk factors. An optimization of the preoperative therapy is able to reduce the preventable cardiac complications. Cardiovascular risk factors such as high blood pressure, diabetes mellitus, heart failure have to be identified and treated.

Laryngeal dislocation after ventral fusion of the cervical spine.

We report on a 70-year-old patient who underwent ventral fusion of the cervical spine (C3/4 and C4/5) for spinal canal stenosis performed by the neurosurgery department. The patient suffered an exceedingly rare complication of the surgery - laryngeal dislocation. Had the deformed laryngeal structures been overlooked and the patient extubated as usual after surgery, reintubation would have been impossible due to the associated swelling, which might have had disastrous consequences.

Quality of postoperative pain using an intraoperatively placed epidural catheter after major lumbar spinal surgery.

Background: Major spinal surgery is associated with high postoperative pain scores and opioid requirement. The aim of the current prospective, randomized, placebo-controlled, double-blind study was to assess the reduction of opioid requirement and pain scores using an intraoperatively placed epidural catheter with infusion of 0.1% ropivacaine during the postoperative period.