scholarly journals Inadvertent severe hypercapnia during general anesthesia: drop-in oxygen saturation or electrocardiography changes; which one warns us earlier?

2022 ◽  
Vol 14 (1) ◽  
Author(s):  
Ali Solhpour ◽  
Ardeshir Tajbakhsh ◽  
Saeid Safari ◽  
Maryam Movaffaghi ◽  
Mohamad Amin Pourhoseingholi ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
General Anesthesia ◽  
Premature Ventricular Contraction ◽  
Warning Sign ◽  
Ventricular Contraction ◽  
High Concentration ◽  
Cardiac Dysrhythmias ◽  
Long Time ◽  
End Tidal ◽  
End Tidal Co2

Abstract Background During general anesthesia especially when the nurse or anesthesiologist forgets to change manual to controlled mode after successful endotracheal intubation, capnography shows End-tidal Co2 above 20 mmHg after checking the place of the tracheal tube and will remain on the screen permanently. In this scenario, the patient receives a high concentration of oxygen, and Spo2 (oxygen saturation) does not drop for a long time which is too late to intervene. It has been all-time questionable which one of the cardiac dysrhythmias or Spo2 dropping occurs earlier. Results Medical records of seven deceased patients reviewed. All of them had electrocardiogram changes including premature ventricular contraction or bradycardia as a first warning sign. Oxygen saturation remains above 95% even with cardiac dysrhythmia. Conclusions Bradycardia and premature ventricular contraction were the first warning findings for severe hypercapnia during general anesthesia and occurred earlier than dropping oxygen saturation. Furthermore, the normal capnography waveform is more reliable than the End-tidal Co2 number for monitoring.

scholarly journals Illinois Dental Anesthesia and Sedation Survey for 2016

2019 ◽  
Vol 66 (2) ◽  
pp. 77-86 ◽  
Author(s):  
William Flick ◽  
Michael Lloyd
Keyword(s):  
General Anesthesia ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Moderate Sedation ◽  
Pediatric Dentists ◽  
General Dentists ◽  
End Tidal ◽  
Electrocardiogram Monitoring ◽  
Staffing Requirements ◽  
End Tidal Co2

A statewide decennial survey was sent to practicing dentists holding sedation or general anesthesia permits to identify office sedation/general anesthesia trends and practices over the last 10 years. This survey constitutes the third such survey, spanning a total of 20 years. Of the 234 respondents in the 2016 survey, 34% held an Illinois moderate sedation permit and 64% held a general anesthesia permit. Oral and maxillofacial surgeons represented the majority of respondents (143/234; 61%). The remainder of responses were from general dentists (39; 17%) pediatric dentists (32; 14%), periodontists (16; 7%), dentist anesthesiologists (3; 1.3%) and 1 periodontist/dentist anesthesiologist. Surveys over the 20 years revealed the following significant trends: an increase in practitioners current in advanced cardiac life support certification, an increase in the number of non-oral maxillofacial surgeons with a sedation permit, an increase in providers of moderate sedation, and an increase in offices equipped with end-tidal CO2 and electrocardiogram monitoring. However, a number of providers were identified as not compliant with certain state mandates. For example, many respondents failed to meet minimum office team staffing requirements during sedation, hold semiannual office emergency drills, and establish written emergency management protocols.

Time course of end-tidal CO2 after Adjustment of ventilatory parameters during stable general anesthesia

2006 ◽  
Vol 23 (Supplement 37) ◽  
pp. 70
Author(s):  
M. Negrau ◽  
M. Filip ◽  
Z. Beres ◽  
L. I. Szegedi ◽  
L. L. Szegedi ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Time Course ◽  
Ventilatory Parameters ◽  
End Tidal ◽  
End Tidal Co2

Cardiovascular and ventilatory response to isocapnic hypoxia at sea level and at 5,050 m

1996 ◽  
Vol 80 (5) ◽  
pp. 1724-1730 ◽  
Author(s):  
G. Insalaco ◽  
S. Romano ◽  
A. Salvaggio ◽  
A. Braghiroli ◽  
P. Lanfranchi ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Sea Level ◽  
Minute Ventilation ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Ventilatory Responses ◽  
Hypoxic Conditions ◽  
Progressive Hypoxia ◽  
End Tidal ◽  
End Tidal Co2

To assess the effect of chronic hypoxic conditions on ventilatory, heart rate (HR), and blood pressure (BP) responses to acute progressive isocapnic hypoxia, we studied five healthy Caucasian subjects (3 men and 2 women). Each subject performed one rebreathing test at sea level (SL) and two tests at the Pyramid laboratory at Lobuche, Nepal, at the altitude of 5,050 m, 1 day after arrival (HA1) and after 24 days of sojourn (HA2). The effects of progressive isocapnic hypoxia were tested by using a standard rebreathing technique. BP, electrocardiogram, arterial oxygen saturation, airflow and end-tidal CO2 and O2 were recorded. For each subject, the relationships between arterial oxygen saturation and HR, systolic BP and minute ventilation (VE), respectively, were evaluated. At HA1, the majority of subjects showed a significant increase in VE and BP response and a decrease in HR response to progressive isocapnic hypoxia as compared to SL. At HA2, VE and BP responses further increased, whereas the HR response remained similar to that observed at HA1. A significant relationship between hypoxic ventilatory responses and both systolic and diastolic BP responses to progressive hypoxia was found. No significant correlation was found between hypoxic ventilatory and HR responses.

scholarly journals I-gel for Positive Pressure Ventilation

2013 ◽  
Vol 52 (189) ◽  
pp. 255-259 ◽  
Author(s):  
Shyam Krishna Maharjan
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Oxygen Saturation ◽  
General Anesthesia ◽  
Tracheal Tube ◽  
Airway Pressure ◽  
Positive Pressure Ventilation ◽  
Randomized Study ◽  
Positive Pressure ◽  
Significant Difference ◽  
End Tidal

Introduction: I-gel is a relatively new supra-glotitc airway device which is claimed to be superior to laryngeal mask airway. It can be used ingeneral anesthesia with spontaneous ventilation as well as with positive pressure ventilation.This study was designed to assess whether I-gel creates adequate laryngeal seal during positive pressure ventilation in patients undergoing laparoscopic surgery. Methods: A prospective randomized study was made among the 60 patients who underwent laparoscopic cholecystectomy under general anesthesia. Airway was managed with either I-gel insertion or endotracheal intubation and positive pressure ventilation in 30 patients each. Airway pressure, end-tidal CO2 and oxygen saturation were monitored and compared between two groups. Inhaled and exhaled tidal volume, minute volume were recorded and leak volume and leak fraction was calculated and compared between two groups. Results: Oxygenation and ventilation (oxygen saturation and end-tidal carbon dioxide pressure) was within normal limit in both groups and comparable. Leak volume in tracheal tube group was 25.33±12.41 ml and in I-gel group it was 26.43±13.19 ml. Leak fraction was 0.0487±0.023 and 0.0417±0.022 in tracheal group and I-gel group respectively. The airway pressure during C02 pneumoperitoneumwas 20.55±3.25 cm H20 in tracheal tube group and 20.21± 3.97 cm H20 in I-gel group and there was no significant leak in either group. Statistically, there was no significant difference in leak volume, leak fraction and airway pressure between the two groups. Conclusions: I- gel may be an alternate to tracheal tube during general anesthesia with positive pressure ventilation in patients with normal airway pressure with acceptable leak, adequate oxygenation and ventilation. Keywords: I gel; Laparoscopic cholecystectomy; positive pressure ventilation; tracheal intubation.  

scholarly journals Choice of dental treatment in adolescent children based on the results of monitoring brain oxygen saturation – cerebral oximetry

2019 ◽  
pp. 54-61
Author(s):  
O.I. Koval
Keyword(s):  
Oral Cavity ◽  
Oxygen Saturation ◽  
General Anesthesia ◽  
Cerebral Oximetry ◽  
Main Task ◽  
Warm Up ◽  
Brain Oxygen ◽  
Dental Procedures ◽  
Long Time ◽  
The Brain

To solve the problem of choosing the method of oral cavity sanitation, it is necessary to determine a safe period of time for performing dental procedures of varying severity and the number of visits. This will provide the opportunity to formulate clear indications for oral sanitation in conditions of general anesthesia in order to minimize the risk of cognitive dysfunctions against the background of hypoxic damage to the brain. The purpose of the study: to establish a safe period of time for various dental procedures in school-aged children on an outpatient dental appointment based on an objective method for assessing brain oxygen saturation – cerebral oximetry; determine the indications for the rehabilitation of the oral cavity under general anesthesia. Dental examination and dental procedures of varying severity were performed for 102 children under the age 12-18 years (424 teeth were treated) at the Dental Medical Center at the Bogomolets National medical University. In order to determine the oxygen saturation of the brain, the cerebral oximetry method was used. To predict cognitive changes against the background of organic brain disorders, we used the results of J. Meixensberger et al. (1998), where the main task of the dentist was considered to prevent a decrease in cerebral oximetry by more than 20%. Statistical processing of the results was performed using Microsoft Office Excel. It is established that the timing of the manipulations associated with preventive measures does not depend on the type of phobias. In children with a “light” temperament, it is 34'-35', with a “complex” temperament and temperament it is “warm up for a long time” – 30'. In children with an “easy” temperament, the safe period of time for conducting manipulations that are associated with the treatment of caries and its complications, regardless of the type of phobia, is 42'. In children with a temperament “a long time warms up”, a safe period of time for carrying out manipulations that are associated with the treatment of caries and its complications, regardless of the type of phobia, is 37'. In children with a “complicated” temperament, a safe period of time for conducting manipulations that are associated with the treatment of caries and its complications in the presence of “elementary” phobias is 35', in the presence of “cryptogenic” phobias – 30'. Indications for rehabilitation of the oral cavity in conditions of general anesthesia at average caries is – children with a “light” temperament, regardless of the type of phobia with a DMF ≥8; children with a “complicated” temperament and “elementary” phobias with a DMF ≥2; “cryptogenic” phobias with DMF ≥1; children with a temperament “warm up for a long time” regardless of the type of phobia with a DMF ≥2; for deep caries – children with a “light” temperament, regardless of the type of phobia with a DMF ≥4; children with a “complicated” temperament and “elementary” phobias with a DMF ≥2; “cryptogenic” phobias with DMF ≥1; children with a temperament “warm up for a long time” regardless of the type of phobia with a DMF ≥1; for chronic fibrous pulpitis – children with a “light” temperament, regardless of the type of phobia with a DMF ≥6; children with a “complicated” temperament, regardless of the type of phobia with a DMF ≥1; children with a temperament “warm up for a long time” regardless of the type of phobia with a DMF ≥2; at chronic periodontitis – children with a “light” temperament, regardless of the type of phobia with a DMF ≥6; children with a “complicated” temperament and “elementary” phobias with a DMF≥2; “Cryptogenic” phobias with DMF ≥1; children with a temperament “warm up for a long time” regardless of the type of phobia with a DMF ≥1. Thus, the treatment of teeth in the conditions of general anesthesia in children aged 12-18 years provides more radical methods of treatment with the obligatory follow-up consultation of the orthodontist in order to preserve the chewing, articulatory functions and to ensure the full development of the dental apparatus.

scholarly journals Physiological Impacts of Personal Protective Equipment on Health Care Workers

2021 ◽  
Vol 10 (1) ◽  
pp. 1
Author(s):  
Anum Arif ◽  
Ahsin Manzoor Bhatti ◽  
Akhter Hussain ◽  
Mohammad Tariq ◽  
Osama Hadi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Care ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Health Care Workers ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
Care Workers ◽  
End Tidal ◽  
End Tidal Co2

Introduction: Since the outbreak of the Ebola virus, its design has constantly been evolving to serve the purpose of protection without hampering the efficiency. In a study conducted in 2019, before the advent of COVID 19, it was found that performing precarious laboratory or clinical works while wearing PPE involved various restrictions compared to the same work without PPE.  The objective of this study is to identify the influence of personal protective equipment on physiological parameters and the individual wellbeing of healthy workers. Methods: This Pilot Quasi-experimental study was performed on 12 volunteers fitting the inclusion criteria. Candidates were seated comfortably and their baseline resting pulse rate, respiratory rate, oxygen saturation via pulse oximeter, blood pressure, and End-tidal CO2 were recorded via a portable monitor. All candidates were asked to wear a KN95 mask along with a 3 ply mask over it and wear anti-fog goggles. All the above-mentioned parameters were recorded again after five minutes of comfortable sitting and ten minutes of brisk walk. Result:   Significant difference is found between resting EtCO2 and after wearing of PPE (P = 0 .044). After a brief exercise, the further rise in EtCO2 is also significant (P = 0.002).  There is no significant rise in pulse after wearing PPE (P = 0.092) but on exertion after wearing PPE, the rise in pulse is statistically significant (P = 0.002). The rest of the variables, such as the rise in respiratory rate, blood pressure, and fall in oxygen saturation rise has no statistical significance. Conclusion: Personal protective equipment has proven to rise in end-tidal carbon dioxide and tachycardia, which can lead to headache, dizziness, and respiratory discomfort. All of the factors can hamper the health care workers' performance and can adversely affect their efficiency.Keywords: covid-19, end tidal CO2, personal protective equipment, physiological 

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