Anesthesia for Carbon Dioxide Laser Microsurgery of the Larynx

1981 ◽  
Vol 89 (5) ◽  
pp. 732-737 ◽  
Author(s):  
Chunilal B. Ruder ◽  
Naomi L. Rapheal ◽  
Allan L. Abramson ◽  
Robert M. Oliverio
Keyword(s):  
Carbon Dioxide Laser ◽  
Muscle Relaxation ◽  
Blood Gases ◽  
Operating Conditions ◽  
Jet Ventilation ◽  
Laser Microsurgery ◽  
Arterial Blood ◽  
Surgical Field ◽  
Intravenous General Anesthesia ◽  
Total Compliance

Jet ventilation via the Sanders injector during intravenous general anesthesia provides excellent operative conditions for CO2 laser microsurgery of the larynx. This technique, which includes complete muscle relaxation, is superior to traditional methods of anesthesia because the endotracheal tube is eliminated, thus improving the surgical field and reducing burn hazards owing to ignition of the tube. The laryngoscope has been modified to carry multiple ports into which a 14-gauge needle is inserted and the tip advanced just distal to the vocal cords. This needle is securely attached to the injector and pressure from the oxygen source is adjusted according to the patient's build and total compliance. Satisfactory arterial blood gases, superb operating conditions, safety, and rapid awakening make this the method of choice for most patients.

Carboxyhaemoglobin levels, pulse oximetry, and arterial blood gases during jet ventilation for Nd-YAG laser bronchoscopy

1990 ◽  
Vol 4 (6) ◽  
pp. 2
Author(s):  
D.R. Goldhill ◽  
A.J. Hill ◽  
R.H. Whitburn ◽  
R.O. Feneck ◽  
J. George ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Jet Ventilation ◽  
Yag Laser ◽  
Arterial Blood

Venturi Jet Ventilation through the Metal Endotracheal Tube: A Nonflammable System

1983 ◽  
Vol 92 (4) ◽  
pp. 405-407 ◽  
Author(s):  
Peak Woo ◽  
M. Stuart Strong
Keyword(s):  
Adverse Effects ◽  
Endotracheal Tube ◽  
Direct Laryngoscopy ◽  
Reliable Method ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Jet Ventilation ◽  
Safe Method ◽  
Arterial Blood ◽  
Laser Excision

In an effort to design a fireproof and reliable method of ventilation during CO2 laser laryngoscopies, a new Venturi jet endotracheal tube coupler has been designed. This allows microdirect laryngoscopy. Its design features are described. Sixteen clinical cases of various laryngeal pathologies treated with direct laryngoscopy and laser excision are ventilated using this system. The clinical data and experiences are discussed. The arterial blood gases done at 20 minutes after muscular paralysis showed a median value of pH 7.45/PO2 252/PCO2 36. No complications or adverse effects were noted. The Venturi jet endotracheal tube coupler allows for jet ventilation through a metal endotracheal tube with reliable ventilation. This is an alternate, reliable, and fire-safe method during laser use.

scholarly journals Evaluation of Medetomidine-Ketamine for Immobilization of Feral Horses in Romania

2021 ◽  
Vol 8 ◽  
Author(s):  
Ovidiu Roşu ◽  
Iulia Melega ◽  
Alina L. Evans ◽  
Jon M. Arnemo ◽  
Susanne Küker
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Rectal Temperature ◽  
Muscle Relaxation ◽  
Health Hazard ◽  
Blood Gases ◽  
Total Carbon ◽  
Feral Horses ◽  
Arterial Blood ◽  
Wide Range

Feral horses are immobilized for a variety of reasons including population control via contraceptives. Although opioid combinations have been successfully used for immobilization of feral horses, there is a need for combinations using drugs that are more readily available and present less of a human health hazard. We evaluated the chemical immobilization with physiological measurements and blood gas analyses of 91 free-ranging feral horses (Equus ferus caballus) remotely immobilized with a combination of 30 mg medetomidine and 775 mg ketamine in a single disposable 6 ml dart. During immobilization, heart rate, respiratory rate, rectal temperature, capillary refill time and peripheral oxygen hemoglobin saturation (SpO2) were evaluated. In eight horses, arterial blood samples were analyzed to evaluate the blood gases, acid-base status and hematologic variables. Targeted horses presented a wide range of age, size and body condition. Eighty-one horses had an uneventful mean induction of 7.2 min. Eighty-nine horses were immobilized in lateral recumbency with good muscle relaxation and a median recumbency time of 67 min. Ten horses required supplemental ketamine intravenously (x̄ = 434 mg) due to incomplete immobilization. In 58 horses the effects of medetomidine were antagonized with atipamezole intravenously. Increased respiratory rate (>20 breaths/min), increased heart rate (>45 beats/min) and decreased SpO2 < 90% were noted in more than half of the individuals, while increased rectal temperature (>39.0°C) was recorded in six animals. Blood parameters showed hypoxemia (<90 mmHg, n = 8), hypercapnia (>45 mmHg, n = 5), high glucose levels (>134 mmol/L, n = 3), increased blood lactate (>1.5 mmol/L), total carbon dioxide, bicarbonate and base excess which further increased in the second sample, whereas SpO2 and calcium values decreased. Recoveries were smooth, with one (n = 86) or more (n = 5) attempts of standing. Eighty-nine recoveries were uneventful, besides one male that showed signs of monoparesis of the left front leg and one mare with signs consistent with exertional myopathy. In conclusion, medetomidine-ketamine provided a reliable immobilization in feral horses over a wide range of body mass and age. However, based on the observed hypoxemia during immobilization, oxygen supplementation is strongly recommended for this protocol.

scholarly journals Total Intravenous Anaesthesia with Ketamine, Medetomidine and Midazolam as Part of a Balanced Anaesthesia Technique in Horses Undergoing Castration

2021 ◽  
Vol 8 (8) ◽  
pp. 142
Author(s):  
Alexandra Cunneen ◽  
Shaun Pratt ◽  
Nigel Perkins ◽  
Margaret McEwen ◽  
Geoffrey Truchetti ◽  
...  
Keyword(s):  
Partial Pressure ◽  
Muscle Relaxation ◽  
Recovery Period ◽  
Blood Gases ◽  
Anaesthetic Technique ◽  
Physiological Variables ◽  
Arterial Partial Pressure ◽  
Arterial Blood ◽  
Anaesthetic Depth

To evaluate the use of ketamine-medetomidine-midazolam total intravenous infusion as part of a balanced anaesthetic technique for surgical castration in horses. Five healthy Standardbred cross colts were premedicated with IV acepromazine (0.01–0.02 mg/kg), medetomidine (7 µg/kg) and methadone (0.1 mg/kg) and anaesthesia induced with IV ketamine (2.2 mg/kg) and midazolam (0.06 mg/kg). Horses were anaesthetised for 40 min with an IV infusion of ketamine (3 mg/kg/h), medetomidine (5 µg/kg/h) and midazolam (0.1 mg/kg/h) while routine surgical castration was performed. Cardiorespiratory variables, arterial blood gases, and anaesthetic depth were assessed at 5 to 10 min intervals. Post-anaesthesia recovery times were recorded, and the quality of the recovery period was assessed. The anaesthetic period and surgical conditions were acceptable with good muscle relaxation and no additional anaesthetic required. The median (range) time from cessation of the infusion to endotracheal tube extubation, head lift and sternal recumbency were 17.2 (7–35) min, 25 (18.9–53) min and 28.1 (23–54) min, respectively. The quality of anaesthetic recovery was good, with horses standing 31.9 (28–61) min after the infusion was ceased. During anaesthesia, physiological variables, presented as a range of median values for each time point were: heart rate 37–44 beats/min, mean arterial pressure 107–119 mmHg, respiratory rate 6–13 breaths/min, arterial partial pressure of oxygen 88–126 mmHg, arterial partial pressure of carbon dioxide 52–57 mmHg and pH 7.36–7.39. In conclusion, the co-administration of midazolam, ketamine and medetomidine as in IV infusion, when used as part of a balanced anaesthetic technique, was suitable for short term anaesthesia in horses undergoing castration.

Endotracheal Intubation and Venturi (Jet) Ventilation for Laser Microsurgery of the Larynx

1976 ◽  
Vol 85 (5) ◽  
pp. 656-663 ◽  
Author(s):  
Martin Lloyd Norton ◽  
M. Stuart Strong ◽  
Charles W. Vaughan ◽  
John C. Snow ◽  
Benjamin J. Kripke
Keyword(s):  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Operating Conditions ◽  
Topical Anesthesia ◽  
Anesthetic Techniques ◽  
Jet Ventilation ◽  
Laser Microsurgery ◽  
Heat Effects ◽  
Surgical Conditions ◽  
Endotracheal Anesthesia

Meeting the exacting requirements for microsurgery of the larynx is a challenge for the anesthesiologist. To accomplish the necessary dissection, the otolaryngologist has several requirements. They are a quiet relaxed field, excellent illumination with magnification, binocular vision for depth perception, and, above all, an unobstructed field. The management of anesthesia for suspension microsurgery on the larynx presents many problems, the most vexing of which is the fact that the otolaryngologist and anesthesiologist are in competition for access to the patient's airway. In sharing this, neither has been able to perform with the degree of control that he would like due to either inadequate operating conditions or insufficient access to ventilatory mechanisms. Several anesthetic techniques have been used for inspection or operative laryngoscopy: topical anesthesia, apneic techniques, translaryngeal topical anesthesia, chest respirator,* neuroleptanalgesia, and general endotracheal anesthesia with muscle relaxants. The latter has proven most popular, particularly in children, because ventilation and surgical conditions are considered to be most controllable. However, the presence of the requisite endotracheal tube obscures the full view of the larynx and vocal cords, and the tube may itself become obstructed. Additionally, use of the laser involves die further risk of heat effects on the endotracheal tube if the beam hits the tube. This report presents our experience and development of the combined technique of endotracheal intubation and Venturi (jet) ventilation. We believe it represents the safest available approach while providing near ideal working conditions for the otolaryngologist during laser microsurgery of the larynx.

Effect of mechanical load on tidal volume during high-frequency jet ventilation

1988 ◽  
Vol 64 (3) ◽  
pp. 1217-1222 ◽  
Author(s):  
G. G. Berdine ◽  
P. J. Strollo
Keyword(s):  
High Frequency ◽  
Mechanical Load ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Jet Ventilation ◽  
Mechanical Loads ◽  
High Frequency Jet Ventilation ◽  
Arterial Blood ◽  
Frequency Independent ◽  
Load Conditions

High-frequency jet ventilation (HFJV) was studied in twelve deeply anesthetized, paralyzed dogs. Entrained volume and total expired volume were directly measured by integration of flow. Jet volume was computed from these measurements. Seven dogs were ventilated with a driving pressure of 10 psi at rates of 2 and 5 Hz for each of three mechanical loads: control, thoracoabdominal wrap, and histamine infusion. Both load conditions reduced total expired volume and entrained volume but had no effect on jet volume. Wrap reduced entrainment more at 2 Hz while the effect of histamine infusion was frequency independent. Control arterial blood gases demonstrated that PO2 was higher and PCO2 was lower during 2 Hz ventilation than during 5 Hz ventilation despite equivalent minute volumes. Five additional dogs were studied using control and wrap loads and an additional ventilator setting of 15 psi at 5 Hz. This group demonstrated that wrap reduces entrainment more at lower frequencies for ventilatory settings providing equivalent gas exchange. We conclude that increasing mechanical load reduces entrainment during HFJV and that this reduction is frequency dependent for restrictive loads.

scholarly journals Reversible anaesthesia of free-ranging lions (Panthera leo) in Zimbabwe

2005 ◽  
Vol 76 (4) ◽  
Author(s):  
A. Fahlman ◽  
A. Loveridge ◽  
C. Wenham ◽  
C. Foggin ◽  
J.M. Arnemo ◽  
...  
Keyword(s):  
Total Dose ◽  
Rectal Temperature ◽  
Muscle Relaxation ◽  
Blood Gases ◽  
Panthera Leo ◽  
Heart Rates ◽  
Arterial Blood ◽  
Drug Doses ◽  
Acid Base Status ◽  
Free Ranging

The combination of medetomidine-zolazepam-tiletamine with subsequent antagonism by atipamezole was evaluated for reversible anaesthesia of free-ranging lions (Panthera leo). Twenty-one anaesthetic events of 17 free-ranging lions (5 males and 12 females, body weight 105-211 kg) were studied in Zimbabwe. Medetomidine at 0.027-0.055 mg / kg (total dose 4-11 mg) and zolazepam-tiletamine at 0.38-1.32 mg / kg (total dose 50-275 mg) were administered i.m. by dart injection. The doses were gradually decreased to improve recovery. Respiratory and heart rates, rectal temperature and relative haemoglobin oxygen saturation (SpO2) were recorded every 15 min. Arterial blood samples were collected from 5 lions for analysis of blood gases and acid-base status. For anaesthetic reversal, atipamezole was administered i.m. at 2.5 or 5 times the medetomidine dose. Induction was smooth and all lions were anaesthetised with good muscle relaxation within 3.4-9.5 min after darting. The predictable working time was a minimum of 1 h and no additional drug doses were needed. Respiratory and heart rates and SpO2 were stable throughout anaesthesia, whereas rectal temperature changed significantly over time. Atipamezole at 2.5 times the medetomidine dose was sufficient for reversal and recoveries were smooth and calm in all lions independent of the atipamezole dose. First sign of recovery was observed 3-27 min after reversal. The animals were up walking 8-26 min after reversal when zolazepamtiletamine doses <1 mg / kg were used. In practice, a total dose of 6 mg medetomidine and 80 mg zolazepam-tiletamine and reversal with 15 mg atipamezole can be used for either sex of an adult or subadult lion. The drugs and doses used in this study provided a reliable, safe and reversible anaesthesia protocol for free-ranging lions.

Dynamics of Venturi Jet Ventilation through the Operating Laryngoscope

1982 ◽  
Vol 91 (6) ◽  
pp. 615-621 ◽  
Author(s):  
Peak Woo ◽  
Stephen Eurenius
Keyword(s):  
Flow Rate ◽  
Minute Ventilation ◽  
Blood Gases ◽  
Optimal Placement ◽  
Jet Ventilation ◽  
Pressure Regulator ◽  
Needle Size ◽  
Pressure Setting ◽  
Arterial Blood ◽  
Total Body

Venturi jet ventilation with the oxygen injector needle placed within the lumen of the laryngoscope was studied systematically in two dogs undergoing repeated general anesthesia suspension laryngoscopy. Using a total body plethysmograph, the effect of changes of needle angle, position and its effect on tidal volume delivery were measured. The changes of pressure regulator, flow rate and needle size were correlated with the volume delivery. Intratracheal pressure during Venturi ventilation was measured. Correlation of arterial blood gases and minute ventilation with the system was done. While ventilatory capacity is able to be achieved predictably, there are many variables. Optimal placement of the needle tip for maximum safety and efficiency appears to be at the midthird or lower third of the laryngoscope. It is important to center the needle axis to the laryngoscope axis. Other parameters subject to choice are the selection of needle size, regulator pressure setting and flow rate setting. By first selecting the correct needle size that will hyperinflate the subject, the pressure regulator can then be reduced to achieve ventilatory volumes similar to spontaneous tidal volumes. In prolonged use, the Venturi system was able to provide excellent ventilation safely and predictably.

scholarly journals Elimination of nasal obstruction improves pulmonary functions and oxygenation

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Eman Sobh ◽  
Fatma Elhussieny ◽  
Taghreed Ismail
Keyword(s):  
Nasal Obstruction ◽  
Blood Gases ◽  
Medical Problem ◽  
Forced Expiratory Volume ◽  
Nasal Packing ◽  
Nasal Pack ◽  
Arterial Blood ◽  
Study Population ◽  
The Mean ◽  
The Impact

Abstract Background Nasal obstruction is a significant medical problem. This study aimed to examine the effect of nasal obstruction and nasal packing on arterial blood gases and pulmonary function indices, and the impact of the elimination of nasal obstruction on preoperative values. Results The mean age of the study population was 26.6 ± 10.1 years, males represented 50.8%. Spirometric indices showed statistically significant improvement (preoperative forced expiratory volume in 1st second 66.9 ± 13.9 vs 79.6 ± 14.9 postoperative and preoperative forced vital capacity 65.5 ± 12.7 vs 80.4 ± 13.8 postoperative). Oxygen saturation was significantly lower during nasal packing (95.6 ± 1.6 preoperative vs 94.7 ± 2.8 with nasal pack), and significant improvement (97.2 ± 1.4) was observed after removal of the nasal pack. Nasal obstruction scores significantly improved. Conclusion The results of this study indicate that either simple nasal obstruction or nasal packing may cause hypoxemia and abnormalities in lung function tests. Hypoxemia was more evident with nasal packing.

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