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3 results

  • Chapter 11 - Anesthesia for video-assisted thoracoscopic surgery

  • from Section 2 - Anesthesia for operative procedures
  • Edited by Cait P. Searl, Sameena T. Ahmed
  • Book:
    Core Topics in Thoracic Anesthesia
    Published online:
    10 December 2009
    Print publication:
    02 April 2009, pp 75-80

  • Summary

    The twin requirements of respiration (ventilation and perfusion) result in the lungs both being exposed to the external environment and the internal environment through the bloodstream. Many of the drugs that people use as anesthetists are metabolized in the lungs including sympathomimetics, antihistamines, opiates and local anesthetics. Drugs used in the treatment of asthma and bronchospasm are bronchodilators, leukotriene antagonists, and magnesium sulphate. Opiates, propofol, thiopentone and muscle relaxants are used during anesthesia on the respiratory system. Mucolytics are prescribed in order to facilitate expectoration by decreasing the viscosity of sputum. They have been shown to benefit some patients with chronic obstructive airways disease and chronic cough with a reduction in exacerbations of the condition. Patients with respiratory disease are likely to be particularly sensitive to small decreases in respiratory muscle function secondary to residual muscle weakness.

  • The effects of atropine on dynamic compliance in healthy intubated adults

  • M. B. Nielsen, T. W. Jespersen, J. R. Larsen, L. Hein
  • Journal:
    European Journal of Anaesthesiology / Volume 17 / Issue 4 / April 2000
    Published online by Cambridge University Press:
    16 August 2006, pp. 236-238
    Print publication:
    April 2000

  • In order to compare the effect of atropine and sodium chloride on the dynamic compliance of the respiratory system after tracheal intubation, we studied 20 patients allocated randomly into two groups to receive either: atropine after 5 min of steady state and sodium chloride after 10 min (group A) or in reverse order (group B) intravenously. The study was conducted in a randomized double-blinded manner. The patients were anaesthetized with thiopental 5 mg kg−1 followed by thiopental 50 mg intravenously, as required. Intubation was facilitated by atracurium 0.5mg kg−1 intravenously and fentanyl 200 μg intravenously. During fixed volume ventilation (100 mL kg−1, f=10), compliance and end-tidal carbon dioxide were measured every 10 s by a Datex AS/3-respiratory module connected to a portable IBM-pc. Five minutes was allowed to establish a steady state then either atropine or sodium chloride was administered according to the protocol. Respiratory dynamic compliance increased significantly after intravenous administration of atropine (P < 0.05). We conclude that atropine 1.0 mg given intravenously provides protection against an intubation-induced decline in respiratory dynamic compliance.

  • Comparison of Inhaled Metaproterenol via Metered-dose and Hand-held Nebulization in Prehospital Treatment of Bronchospasm

  • Steven J. Rottman, Nancy E. Robinson, Marvin L. Birnbaum
  • Journal:
    Prehospital and Disaster Medicine / Volume 11 / Issue 4 / December 1996
    Published online by Cambridge University Press:
    28 June 2012, pp. 280-284
    Print publication:
    December 1996
  • Introduction:

    Although the efficacy of the administration of beta-adrenergic bronchodilators has been demonstrated, the best method available for the delivery of these drugs in the prehospital setting has not been defined. This paper compares the effects of administration of metaproterenol when administered by paramedics using either a metered-dose inhaler (MDI) or a hand-held nebulizer (HHN).

    Hypothesis:

    There is no difference in the effects produced in patients suffering from smooth bronchiolar muscle spasm by metaproterenol when delivered either by a standard metered-dose inhaler or with a hand-held nebulizer.

    Participants:

    Consecutive prehospital patients complaining of difficulty breathing with clinical evidence of bronchospasm and with a history of asthma, chronic obstructive pulmonary disease, or emphysema who were not in extremis.

    Methods:

    Prior to the administration of metaproterenol, a peak expiratory flow rate (PEFR) was obtained. This measurement was repeated five minutes following the conclusion of the administration of metaproterenol. Patients in Burbank, California, received the treatment using a standard metered-dose inhaler, and those in Madison, Wisconsin, received the drug using a hand-held nebulizer. Peak expiratory flow rates were compared using Student's t-tests with Bonferroni's correction. Statistical significance was set at p <0.05.

    Results:

    Data were collected from 36 consecutive patients by the paramedics of the Burbank Fire Department and from 32 consecutive patients by the paramedics of the Madison Fire Department. For the metered-dose inhaler group, the mean value for peak expiratory flow rate for the pre-treatment test was 95.4 ±88.1 1/min, and after treatment was 109.4 ±89.3 1/min (p <0.001). For the hand-held nebulizer group, the mean value for peak expiratory flow rate before the administration of the metaproterenol was 96.1 ±76.3 1/min and following the treatment was 149.1 ±92.9 1/min (p <0.001). The mean values for the differences between the control peak expiratory flow rate and the post-treatment peak expiratory flow rate for the metered-dose inhaler group was +14.0 ±27.4 1/min, and for the hand-held nebulizer group was +53.0 ±69.1 1/min (p <0.003).

    Conclusions:

    In the prehospital setting the administration of metaproterenol using a hand-held nebulizer is more effective than delivering the drug using a metered-dose inhaler. The hand-held nebulizer is easier to use and delivers a higher dose of the drug than is convenient using the metered-dose inhaler.