scholarly journals Causes, Effects and Methods of Monitoring Gas Exchange Disturbances during Equine General Anaesthesia

Animals ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 2049
Author(s):  
Elżbieta Stefanik ◽  
Olga Drewnowska ◽  
Barbara Lisowska ◽  
Bernard Turek
Keyword(s):  
Gas Exchange ◽  
General Anaesthesia ◽  
Near Infrared ◽  
Respiratory Acidosis ◽  
Monitoring Methods ◽  
Arterial Blood Gas ◽  
Complementary Method ◽  
Arterial Blood ◽  
Operative Complications ◽  
Post Operative Complications

Horses, due to their unique anatomy and physiology, are particularly prone to intraoperative cardiopulmonary disorders. In dorsally recumbent horses, chest wall movement is restricted and the lungs are compressed by the abdominal organs, leading to the collapse of the alveoli. This results in hypoventilation, leading to hypercapnia and respiratory acidosis as well as impaired tissue oxygen supply (hypoxia). The most common mechanisms disturbing gas exchange are hypoventilation, atelectasis, ventilation–perfusion (V/Q) mismatch and shunt. Gas exchange disturbances are considered to be an important factor contributing to the high anaesthetic mortality rate and numerous post-anaesthetic side effects. Current monitoring methods, such as a pulse oximetry, capnography, arterial blood gas measurements and spirometry, may not be sufficient by themselves, and only in combination with each other can they provide extensive information about the condition of the patient. A new, promising, complementary method is near-infrared spectroscopy (NIRS). The purpose of this article is to review the negative effect of general anaesthesia on the gas exchange in horses and describe the post-operative complications resulting from it. Understanding the changes that occur during general anaesthesia and the factors that affect them, as well as improving gas monitoring techniques, can improve the post-aesthetic survival rate and minimize post-operative complications.

scholarly journals Apnoeic oxygenation using transnasal humidified rapid-insufflation ventilatory exchange during rigid bronchoscopy: a report of four cases

2022 ◽  
Vol 50 (1) ◽  
pp. 030006052110683
Author(s):  
Jaewoong Jung ◽  
Juhui Park ◽  
Misoon Lee ◽  
Yang-Hoon Chung
Keyword(s):  
General Anaesthesia ◽  
Flow Rate ◽  
Outlet Obstruction ◽  
Respiratory Acidosis ◽  
Bronchial Tube ◽  
Rigid Bronchoscopy ◽  
Gas Analysis ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Apnoeic Oxygenation

General anaesthesia with a muscle relaxant is usually performed for rigid bronchoscopy (RB), but ventilation is challenging due to large amounts of leakage. Optiflow™ supplies 100% humidified, warmed oxygen at a rate of up to 70 l/min and this high flow rate may overcome the leakage problem. This case report describes four patients that were scheduled for RB. The lung lesions were all located below the carina, so a bronchial tube was inserted under general anaesthesia. Once a large amount of leakage was confirmed by manual ventilation, Optiflow™ was connected to the bronchial tube (flow rate, 70 l/min). All of the ports of the bronchoscopy were left open to prevent the risk of outlet obstruction. Oxygenation was well maintained with stable vital signs throughout the procedures, which took up to 34 min without airway intervention. There were no occurrences of cardiac arrhythmia or changes in the electrocardiograms. Respiratory acidosis recovered after emergence, which was confirmed by arterial blood gas analysis in all cases. Apnoeic oxygenation using Optiflow™ was applied successfully during RB. Applying Optiflow™ could make cases of difficult ventilation during RB much easier for the anaesthetist. Larger studies need to demonstrate the efficacy and safety of this technique.

scholarly journals d-Cystine di(m)ethyl ester reverses the deleterious effects of morphine on ventilation and arterial blood gas chemistry while promoting antinociception

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Benjamin Gaston ◽  
Santhosh M. Baby ◽  
Walter J. May ◽  
Alex P. Young ◽  
Alan Grossfield ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Intracellular Signaling ◽  
Dimethyl Ester ◽  
Diethyl Ester ◽  
Blood Gas ◽  
Negative Effects ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Gas Chemistry ◽  
Ventilatory Drive

AbstractWe have identified thiolesters that reverse the negative effects of opioids on breathing without compromising antinociception. Here we report the effects of d-cystine diethyl ester (d-cystine diEE) or d-cystine dimethyl ester (d-cystine diME) on morphine-induced changes in ventilation, arterial-blood gas chemistry, A-a gradient (index of gas-exchange in the lungs) and antinociception in freely moving rats. Injection of morphine (10 mg/kg, IV) elicited negative effects on breathing (e.g., depression of tidal volume, minute ventilation, peak inspiratory flow, and inspiratory drive). Subsequent injection of d-cystine diEE (500 μmol/kg, IV) elicited an immediate and sustained reversal of these effects of morphine. Injection of morphine (10 mg/kg, IV) also elicited pronounced decreases in arterial blood pH, pO2 and sO2 accompanied by pronounced increases in pCO2 (all indicative of a decrease in ventilatory drive) and A-a gradient (mismatch in ventilation-perfusion in the lungs). These effects of morphine were reversed in an immediate and sustained fashion by d-cystine diME (500 μmol/kg, IV). Finally, the duration of morphine (5 and 10 mg/kg, IV) antinociception was augmented by d-cystine diEE. d-cystine diEE and d-cystine diME may be clinically useful agents that can effectively reverse the negative effects of morphine on breathing and gas-exchange in the lungs while promoting antinociception. Our study suggests that the d-cystine thiolesters are able to differentially modulate the intracellular signaling cascades that mediate morphine-induced ventilatory depression as opposed to those that mediate morphine-induced antinociception and sedation.

scholarly journals The effects of lung volume reduction treatment on diffusing capacity and gas exchange

2020 ◽  
Vol 29 (158) ◽  
pp. 190171
Author(s):  
Marlies van Dijk ◽  
Karin Klooster ◽  
Nick H.T. Ten Hacken ◽  
Frank Sciurba ◽  
Huib. A.M. Kerstjens ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Lung Volume ◽  
Diagnostic Techniques ◽  
Volume Reduction ◽  
Diffusing Capacity ◽  
Blood Gas ◽  
Lung Volume Reduction ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Blood Gas Parameters

Lung volume reduction (LVR) treatment in patients with severe emphysema has been shown to have a positive effect on hyperinflation, expiratory flow, exercise capacity and quality of life. However, the effects on diffusing capacity of the lungs and gas exchange are less clear. In this review, the possible mechanisms by which LVR treatment can affect diffusing capacity of the lung for carbon monoxide (DLCO) and arterial gas parameters are discussed, the use of DLCO in LVR treatment is evaluated and other diagnostic techniques reflecting diffusing capacity and regional ventilation (V′)/perfusion (Q′) mismatch are considered.A systematic review of the literature was performed for studies reporting on DLCO and arterial blood gas parameters before and after LVR surgery or endoscopic LVR with endobronchial valves (EBV). DLCO after these LVR treatments improved (40 studies, n=1855) and the mean absolute change from baseline in % predicted DLCO was +5.7% (range −4.6% to +29%), with no real change in blood gas parameters. Improvement in V′ inhomogeneity and V′/Q′ mismatch are plausible explanations for the improvement in DLCO after LVR treatment.

Ubiquitin C-Terminal Hydrolase 1 and Phosphorylated Axonal Neurofilament Heavy Chain in Infants Undergoing Cardiac Surgery: Preliminary Assessment as Potential Biomarkers of Brain Injury

2018 ◽  
Vol 9 (4) ◽  
pp. 412-418
Author(s):  
Timothy Lee ◽  
Sathish M. Chikkabyrappa ◽  
Diane Reformina ◽  
Amanda Mastrippolito ◽  
Sujata B. Chakravarti ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Brain Injury ◽  
Heavy Chain ◽  
Near Infrared ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Significant Rise ◽  
Enzyme Linked Immunosorbent Assay ◽  
Arterial Blood Gas ◽  
Arterial Blood

Background: There are no reliable markers to assess brain injury in neonates following cardiac surgery. We examine ubiquitin C-terminal hydrolase 1 (UCHL1) and phosphorylated axonal neurofilament heavy chain (pNF-H), neuronal-specific biomarkers released following axonal and cortical injury, in neonates undergoing cardiac surgery involving cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). Methods: Twenty-six patients younger than three months were prospectively enrolled (CPB only, n = 12 and DHCA, n = 14). Healthy newborns (n = 22) served as the control. Blood samples were collected preoperatively and postoperatively upon intensive care unit admission (hour 0) and subsequently at 12, 24, 36, and 48 hours. Serum was tested for UCHL1 and pNF-H using enzyme-linked immunosorbent assay. Concomitant arterial blood gas, lactate, and cerebral near-infrared spectroscopy (NIRS) monitoring were performed. Results: Ubiquitin C-terminal hydrolase 1 showed a significant rise at 0 hours in the DHCA group compared to baseline (74.9 ± 13.7 pg/mL vs 33.9 ± 37.3 pg/mL, P < .0001). Levels returned to baseline at 12 hours. There was an early rise in UCHL1 at 0 hours in the CPB group, P = .09. Phosphorylated axonal neurofilament heavy chain was decreased at 0 hours in both the CPB and DHCA groups compared to baseline, P = .06. There was no difference between control and baseline levels of UCHL1 ( P = .9) or pNF-H ( P = .77). Decreased NIRS was observed in the DHCA group at 0 hours (57.3 ± 10.5) versus baseline (64.2 ± 12.3), but not significant ( P = .21). There was no correlation between biomarkers and NIRS at 0 hours. Conclusion: A rapid rise in UCHL1 levels was observed in the DHCA group, suggesting that it may be a marker for acute brain injury. Follow-up with neurodevelopmental studies is ongoing.

scholarly journals Intubation prognosis in COVID-19 patients and associated factors: a cross-sectional study

2020 ◽  
Author(s):  
Mostafa Mohammadi ◽  
Hesam Aldin Varpaei ◽  
Majid Amini
Keyword(s):  
Clinical Signs ◽  
Respiratory Acidosis ◽  
Absolute Lymphocyte Count ◽  
Clinical Severity ◽  
Common Finding ◽  
Cross Sectional ◽  
Arterial Blood Gas ◽  
Laboratory Parameters ◽  
Arterial Blood ◽  
Wide Range

Abstract Background: In December 2019, a new pathogen, HCoV, or New Corona Virus 2019 (2019-nCoV), was recognized in Wuhan, China, causing a pandemic. COVID-19 has a wide range of clinical severity. Approximately 3.2% of patients within some periods of the disease require intubation and invasive ventilation. Methods: This study was descriptive-analytical and was conducted in the Imam Khomeini Hospital. Patients with Covid-19 who required endotracheal intubation were identified and their clinical signs and laboratory parameters were recorded. SPSS23 software was used for statistical analysis. Results: 120 patients with coronavirus with different conditions were evaluated. The mean age was 55±14. 30 patients had cardiovascular disease (hypertension) and 20 endocrine disease(diabetes). Respiratory acidosis, decreased oxygen saturation, lymphopenia, and increased CRP were the most common finding before intubation. 31 patients had no comorbidity conditions. However, 27 patients had more than one comorbidity condition, and 23 experienced acute respiratory distress syndrome. The mortality rate was 49.2%. Discussion: Although all laboratory parameters and patients symptoms can affect the treatment outcome, it was found that WBC and absolute lymphocyte count, BUN, SOFA and APACHE scores, inflammatory index ratio CRP / LDH % CRP / ESR% and ESR / LDH%, arterial blood gas indices, pulse rate, and patient temperature before intubation are among the parameters that can affect the patient's 14-day prognosis. Conclusion: Except for the mentioned items, CRP / LDH% ratio seems to be a good indicator for checking the prognosis of discharge or death of patients within 14 days, However, CRP / ESR% and ESR / LDH% are appropriate criteria for determining the prognosis for discharge or stay in the ICU for more than 14 days.

THE STUDY ON ARTERIAL BLOOD GAS IN PATIENTS WITH ACUTE STROKE

2017 ◽  
pp. 37-45
Author(s):  
Xuan Tai Nguyen ◽  
Dinh Toan Nguyen
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Scale Score ◽  
Negative Correlation ◽  
Hemorrhagic Stroke ◽  
Respiratory Acidosis ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Time Of Admission

Objectives: 1) To investigate the variation in arterial blood gas in patients with acute stroke according to ischemic stroke and hemorrhagic stroke. 2) To determine the correlation and relevance between arterial blood gas and Glasgow scale score, NIHSS, volume of brain damage on computed tomography imaging. Subjects and methods: A cross-sectional study was done in 70 patients with acute stroke. Results: Reduced rates of PCO2, PO2, SaO2 at the time of admission were 56.2%, 25%, 18.8% in ischemic stroke and 44.4%, 72.2%, 63% in hemorrhagic stroke. At the time of 24 hours, these rates were 75%, 56.2%, 50% in ischemic stroke and 50%, 79.6%, 70.4% in hemorrhagic stroke. At the time of 48 hours, these rates were 68.7%, 50%, 18.8% in ischemic stroke and 53.7%, 59.3%, 44.4% in hemorrhagic stroke. Respiratory acidosis was only present at hemorrhagic stroke. Respiratory alkalosis was in both stroke style and had the highest proportion. At the time of admission, SaO2 was negatively correlated with damage volume (r=- 0.264, p<0.05). HCO3- correlated with Glasgow (r=0.323; p<0.01) and NIHSS (r=-0.274; p<0.05). At the time of 24 hours, there was a negative correlation between PO2 (r=-0.375, p=0.001) and SaO2 (r =-0.39, p<0.01) with NIHSS. There was a negative correlation between PO2 (r=-0.435) and SaO2 (r=-0.457) with damage volume (p <0.0001). At the time of 48 hours, there was a negative correlation between PCO2, PO2 and SaO2 with NIHSS (r=-0.312, p<0.01, r=-0.35, p=0.01 and r=-0.0270, p<0.05). PCO2 was positively correlated with Glasgow (r = 0.260, p <0.05). There was a negative correlation between PO2 (r = - 0.391, p = 0.001) and SaO2 (r = - 0.421, p <0.001) with damage volume. Conclusions: In stroke patients, disturbances on ABG they are surfered from (acid-base disorders, hypoxemia) affect directly or indirectly on brain cells. Secondary brain damages could be well prevented if these disturbances is diagnosed and treated promptly. Key words: Stroke, arterial blood gas, Glasgow scale score, NIHSS

Alteration in gas exchange related to body position

1990 ◽  
Vol 10 (1) ◽  
pp. 56-59 ◽  
Author(s):  
A Robichaud
Keyword(s):  
Gas Exchange ◽  
Patient Care ◽  
Body Position ◽  
Blood Gas ◽  
Arterial Blood Gas ◽  
Care Plans ◽  
Arterial Blood

The diagnosis of alteration in gas exchange related to body position requires a deliberate evaluation of PaO2 responses. Body positions that improve V/Q matching and thus PaO2 need to be specified in patient care plans; individualized interventions are more useful than generic care plans that state, "turn q 2 h." Additionally, standard rotations for patients treated on mechanically rotating beds could be individualized according to gas exchange responses to the position changes. Routine documentation of patient body positions next to arterial blood gas results on flow sheets could prove valuable in the evaluation and treatment of hypoxemia in patients with pulmonary problems.

ADJUSTMENT OF VENTILATION, INTRAPULMONARY GAS EXCHANGE, AND ACID-BASE BALANCE DURING THE FIRST DAY OF LIFE

PEDIATRICS ◽  
1964 ◽  
Vol 33 (5) ◽  
pp. 682-693
Author(s):  
L. Samuel Prod'hom ◽  
Henry Levison ◽  
Ruth B. Cherry ◽  
James E. Drorbaugh ◽  
John P. Hubbell ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Respiratory Distress ◽  
Respiratory Acidosis ◽  
Acid Base Balance ◽  
Acid Base ◽  
Infants Of Diabetic Mothers ◽  
Arterial Blood ◽  
Physiologic Dead Space ◽  
Base Balance ◽  
Diabetic Mothers

Determinations of blood gases and of acid-base balance were done in umbilical vein and artery blood at birth and in arterial blood at the age of 20 minutes in 20 infants of diabetic mothers. All were born by cesarean section, 18 of them between 36 and 37 weeks gestation. None showed respiratory distress at any time. Ventilation, gaseous metabolism, functional residual capacity, intrapulmonary gas exchange, and acid-base balance were determined at the age of 1, 4, and 24 hours in these 20 infants. The results indicate the following conclusions with regard to infants of diabetic mothers. 1. Adjustment of ventilation to perfusion in the lung appears to be complete at 4 hours of life. 2. Throughout the first 24 hours there is a persistence of an over-all true right to left shunt of approximately 20-25% of the total cardiac output. The exact localization of this shunt is unknown. 3. Acid-base balance in cord blood and in arterial blood during the first day of life in infants of diabetic mothers differs only slightly from that of infants of nondiabetic mothers. At 1 and 4 hours of age there is some persistence of a slight respiratory acidosis. 4. At 24 hours infants of diabetic mothers have the usual low arterial Pco2 of other newborn infants, but a ventilation equivalent of 16.5, which is normal for adults. 5. Although 6 of the 17 infants studied at 4 hours have shown a respiratory rate above 60 without other signs of respiratory distress, these infants with high rates had small tidal volumes, high physiologic dead-space/tidal volume ratios, and relatively little increase in minute volume.

scholarly journals The physiological basis of pulmonary gas exchange: implications for clinical interpretation of arterial blood gases

2014 ◽  
Vol 45 (1) ◽  
pp. 227-243 ◽  
Author(s):  
Peter D. Wagner
Keyword(s):  
Gas Exchange ◽  
Clinical Care ◽  
Physiological State ◽  
Pulmonary Gas Exchange ◽  
The Body ◽  
Blood Gas ◽  
Physiological Basis ◽  
Basic Principles ◽  
Arterial Blood Gas ◽  
Arterial Blood

The field of pulmonary gas exchange is mature, with the basic principles developed more than 60 years ago. Arterial blood gas measurements (tensions and concentrations of O2and CO2) constitute a mainstay of clinical care to assess the degree of pulmonary gas exchange abnormality. However, the factors that dictate arterial blood gas values are often multifactorial and complex, with six different causes of hypoxaemia (inspiratory hypoxia, hypoventilation, ventilation/perfusion inequality, diffusion limitation, shunting and reduced mixed venous oxygenation) contributing variably to the arterial O2and CO2tension in any given patient. Blood gas values are then usually further affected by the body's abilities to compensate for gas exchange disturbances by three tactics (greater O2extraction, increasing ventilation and increasing cardiac output). This article explains the basic principles of gas exchange in health, mechanisms of altered gas exchange in disease, how the body compensates for abnormal gas exchange, and based on these principles, the tools available to interpret blood gas data and, quantitatively, to best understand the physiological state of each patient. This understanding is important because therapeutic intervention to improve abnormal gas exchange in any given patient needs to be based on the particular physiological mechanisms affecting gas exchange in that patient.

Measurement and analysis of gas exchange during exercise using a programmable calculator

1980 ◽  
Vol 49 (3) ◽  
pp. 456-461 ◽  
Author(s):  
D. Y. Sue ◽  
J. E. Hansen ◽  
M. Blais ◽  
K. Wasserman
Keyword(s):  
Gas Exchange ◽  
Respiratory Exchange Ratio ◽  
Minute Ventilation ◽  
Co2 Production ◽  
O2 Consumption ◽  
Exercise Tests ◽  
Programmable Calculator ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
End Tidal

Although exercise testing is useful in the diagnosis and management of cardiovascular and pulmonary diseases, a rapid comprehensive method for measurement of ventilation and gas exchange has been limited to expensive complex computer-based systems. We devised a relatively inexpensive, technically simple, and clinically oriented exercise system built around a desktop calculator. This system automatically collects and analyzes data on a breath-by-breath basis. Our calculator system overcomes the potential inaccuracies of gas exchange measurement due to water vapor dilution and mismatching of expired flow and gas concentrations. We found no difference between the calculator-derived minute ventilation, CO2 production, O2 consumption, and respiratory exchange ratio and the values determined from simultaneous mixed expired gas collections in 30 constant-work-rate exercise studies. Both tabular and graphic displays of minute ventilation, CO2 production, O2 consumption, respiratory exchange ratio, heart rate, end-tidal O2 tension, end-tidal CO2 tension, and arterial blood gas value are included for aid in the interpretation of clinical exercise tests.

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