Clinics in Anaesthesiology最新文献_第10页

Clinics in Anaesthesiology Pub Date : 1985-10-01 Epub Date: 2021-03-23 DOI: 10.1016/S0261-9881(21)00097-5

Ken Hillman

{"title":"Pulmonary Barotrauma","authors":"Ken Hillman","doi":"10.1016/S0261-9881(21)00097-5","DOIUrl":"https://doi.org/10.1016/S0261-9881(21)00097-5","url":null,"abstract":"<div><p>Barotrauma is a well-recognized complication of positive pressure ventilation. Excessive pressure applied to the lungs causes widespread disruption of alveoli. The gas escapes into the perivascular space to form pulmonary interstitial emphysema (PIE). The small bubbles coalesce and stream towards the mediastinum. The gas either accumulates there, or if the pressure is continued, it moves up into the neck and over the body to form subcutaneous emphysema, ruptures the mediastinal pleura to cause a pneumothorax, or moves down alongside the aorta and oesophagus to form pneumoretroperitoneum and with even higher pressures, pneumoperitoneum. The danger from extra-alveolar air (EAA) in the form of pneumothoraces, is well recognized. However, gas in the other sites can also cause complications. Lung disruption caused by PIE can cause hypoxia and hypercarbia, as well as more chronic respiratory impairment in the form of bronchopulmonary dysplasia (BPD). Cardiorespiratory embarrassment can result from mediastinal emphysema and upper airways obstruction from subcutaneous emphysema. Splinting of the diaphragms and cardiovascular impairment can be caused by raised intraabdominal pressure associated with pneumoretroperitoneum and pneumoperitoneum. Like many conditions in medicine, the best way of managing barotrauma is prevention. There are now alternative ways of artificially maintaining gas exchange apart from conventional ventilation and PEEP. Techniques such as CPAP, reversed inspiration: expiration (I: E) ratios, IMV, LFPPV with ECRCO<sub>2</sub> and hypoxic pulmonary vasoconstriction can often maintain gas exchange at lower airway pressures than IPPV and PEEP. As a result, there is less cardiovascular depression and a much lower incidence of lung disruption by barotrauma.</p></div>","PeriodicalId":100281,"journal":{"name":"Clinics in Anaesthesiology","volume":"3 4","pages":"Pages 877-898"},"PeriodicalIF":0.0,"publicationDate":"1985-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136818643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Copyright Page 版权页

Clinics in Anaesthesiology Pub Date : 1985-07-01 Epub Date: 2021-03-23 DOI: 10.1016/S0261-9881(21)00046-X

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Title Page 标题页

Clinics in Anaesthesiology Pub Date : 1985-07-01 Epub Date: 2021-03-23 DOI: 10.1016/S0261-9881(21)00045-8

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Fluid Balance 液平衡

Clinics in Anaesthesiology Pub Date : 1985-07-01 Epub Date: 2021-03-23 DOI: 10.1016/S0261-9881(21)00054-9

Edward J. Bennett, Denis E. Bowyer

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Inhalation Agents in Paediatric Anaesthesia 吸入剂在儿科麻醉中的应用

Clinics in Anaesthesiology Pub Date : 1985-07-01 Epub Date: 2021-03-23 DOI: 10.1016/S0261-9881(21)00051-3

Frederic A. Berry

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Monitoring During Paediatric Anaesthesia 儿科麻醉期间的监测

Clinics in Anaesthesiology Pub Date : 1985-07-01 Epub Date: 2021-03-23 DOI: 10.1016/S0261-9881(21)00055-0

Edward F. Battersby

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The Postoperative Period 术后期

Clinics in Anaesthesiology Pub Date : 1985-07-01 Epub Date: 2021-03-23 DOI: 10.1016/S0261-9881(21)00056-2

Alan Duncan

{"title":"The Postoperative Period","authors":"Alan Duncan","doi":"10.1016/S0261-9881(21)00056-2","DOIUrl":"https://doi.org/10.1016/S0261-9881(21)00056-2","url":null,"abstract":"<div><p>Although advances in paediatric surgery and anaesthesia have virtually eliminated unexpected perioperative mortality, considerable morbidity remains. Pain and vomiting are common postoperative problems that are physically and psychologically harmful to the child. Pain can be reduced or eliminated by a planned approach to the conduct of anaesthesia and the management of the postoperative period. A continuous infusion of morphine or other opiate analgesics is safe even in small infants, minimizing the risk of respiratory depression and vomiting. Similarly, the use of long-acting local anaesthetic agents for neural blockade can guarantee profound analgesia for prolonged periods. The local and regional techniques employed in adults can be safely applied to co-operative children either intraoperatively or postoperatively. The incidence of vomiting after anaesthesia remains unacceptably high in most institutions. It can be reduced by avoidance of opiates for premedication and the use of continuous low-dose infusions of opiates and neural blockade for postoperative analgesia.</p><p>Infants and children, like adults, undergo a metabolic response to surgery including catabolic and anabolic phases. Although less profound, increased metabolism, fluid retention and wasting still occur. The infant in the first two years of life has a markedly reduced respiratory reserve. Immaturity, structural defects of the respiratory and other systems, and postoperative pain and abdominal distension may precipitate respiratory failure. The infant is also prone to airways obstruction, largely as a result of the small calibre of the airways in absolute terms. Facilities for paediatrically orientated intensive care must be available for hospitals contemplating neonatal and infant surgery. On most occasions, the need for postoperative cardiorespiratory support and intensive observation can be anticipated, although rarely it may be required as a result of unexpected complications.</p></div>","PeriodicalId":100281,"journal":{"name":"Clinics in Anaesthesiology","volume":"3 3","pages":"Pages 619-632"},"PeriodicalIF":0.0,"publicationDate":"1985-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137227258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Index 指数

Clinics in Anaesthesiology Pub Date : 1985-07-01 Epub Date: 2021-03-23 DOI: 10.1016/S0261-9881(21)00064-1

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Resuscitation in Paediatrics 儿科复苏

Clinics in Anaesthesiology Pub Date : 1985-07-01 Epub Date: 2021-03-23 DOI: 10.1016/S0261-9881(21)00063-X

David A. Zideman

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Day Stay Surgery in Paediatrics 儿科日间外科

Clinics in Anaesthesiology Pub Date : 1985-07-01 Epub Date: 2021-03-23 DOI: 10.1016/S0261-9881(21)00059-8

John P. Keneally

{"title":"Day Stay Surgery in Paediatrics","authors":"John P. Keneally","doi":"10.1016/S0261-9881(21)00059-8","DOIUrl":"https://doi.org/10.1016/S0261-9881(21)00059-8","url":null,"abstract":"<div><p>Day stay surgery is well established in paediatric practice. Its success depends on careful attention to patient selection and preparation, with the provision of adequate information and advice to parents both pre- and postoperatively. Units in which it is performed must offer the same standards of medical staff, nursing care and equipment as for inpatients, with access to full hospital facilities readily available.</p><p>Anaesthetists should be involved in the establishment of guidelines for day stay programmes and their continuing critical review. Their chief responsibility, however, is in the selection of techniques which provide pleasant induction of anaesthesia with rapid recovery, minimize complications and allow early discharge. The best methods of achieving these aims are still controversial, especially in relation to premedication and analgesia. That this is so, points firstly to the deficiencies of currently available sedative and analgesic drugs and explains the increasingly wide use of local anaesthetic techniques in the last decade. Secondly, it illustrates the need to recognize the differences in the practical functioning of various institutions and the requirements of individual patients. Ultimately, it is only in responding to those individual requirements that a day stay programme will achieve its potential medical, social and economic advantages for society and the family.</p></div>","PeriodicalId":100281,"journal":{"name":"Clinics in Anaesthesiology","volume":"3 3","pages":"Pages 679-696"},"PeriodicalIF":0.0,"publicationDate":"1985-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137227545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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