Respiration in anesthesia: pathophysiology and clinical update
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
| Schriftenreihe: | Anesthesiology clinics of North America
16,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV, 321 S. Ill., graph. Darst. |
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Datensatz im Suchindex
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| adam_text | RESPIRATION IN ANESTHESIA:
PATHOPHYSIOLOGY AND CLINICAL UPDATE
CONTENTS
Foreword xi
Jonathan L. Benumof
Preface xiii
Peter H. Breen
Anesthesia Machine and Circuit: Portal to the Respiratory
System 1
Randall L. Goode and Peter H. Breen
A clear understanding of the anesthesia machine and breathing
circuit is essential, for it becomes part of the respiratory system
during general anesthesia. This article reviews the basic funda¬
mentals of the modern anesthesia machine and circuit and high¬
lights important features that contribute to patient safety. In a
step by step manner, gas flow is followed through the machine
and circuit for delivery to the patient.
Pathophysiology, Evaluation, and Treatment of the
Difficult Airway 29
William C. Wilson and Jonathan L. Benumof
In this article, the authors review the important consideration
that all anesthesiologists should be aware of when evaluating and
caring for patients with difficult airways. Difficult ventilation has
different considerations than difficult endotracheal intubation,
thus the authors cover these areas separately. After describing the
general issues of the difficult airway the authors review two
particularly troublesome areas: difficult airway in the trauma
patient and difficult airway in the parturient.
ANESTHESIOLOGY CLINICS OF NORTH AMERICA
VOLUME 16 • NUMBER 1 • MARCH 1998 vii
Inhalation Anesthetics and Control of Breathing During
Hypoxia 77
Denham S. Ward
Control of ventilation is under both metabolic control through
the chemoreceptors as well as behavioral control. This article
reviews the complex interaction of the inhalational anesthetics in
sedative levels on the ventilatory response to hypoxia, attempting
to account for effects on both behavioral and chemoreceptor ef¬
fects.
Asthma: Current Pathophysiology and Treatment 89
David O. Warner
At least 10 million Americans suffer from asthma, one of the
most common chronic diseases in the United States. Disturbingly,
both the incidence and severity of asthma appear to be increasing,
especially among the urban poor, despite the concerted efforts of
health care providers. Some forms of asthma therapy have been
implicated as contributing to sudden death in these patients. It is
increasingly important to properly manage patients with asthma
in the perioperative period. This article presents current thought
regarding the pathophysiology and treatment of asthma and out¬
lines an approach to the perioperative care of these patients.
Gas Exchange Pathophysiology During Anesthesia 113
Goran Hedenstierna
Pulmonary gas exchange is regularly impaired in the anesthetized
patient. Although the impairment is simple to overcome in most
patients by increasing the inspired oxygen fraction, hypoxemia
may ensue. The mechanisms behind the impairment, in articular
atelectasis formation, are discussed. Procedures to prevent lung
collapse and to improve gas exchange are analyzed.
Neonatal Respiratory Failure: Current Ventilator
Management Strategies 129
Alison B. Froese
The current challenge in neonatal ventilatory care is to select
among proliferating options. Conventional ventilators offer a
growing variety of triggering sensors, synchronization options,
and waveform analysis. A variety of high frequency ventilator
devices are readily available, as are centers offering extra corpo¬
real membrane oxygenation (ECMO). Clinical trials of partial
liquid ventilation are underway. These developments need to
be evaluated in the context of a growing understanding of the
mechanisms of ventilator related lung injury.
Viii CONTENTS
ARDS: Current Treatment and Ventilator Strategies 155
Michael F. O Connor and Jesse B. Hall
Patients with adult respiratory distress syndrome (ARDS) remain
extremely challenging to the intensivist during their intensive
care unit (ICU) management and the anesthesiologist caring for
them intraoperatively. This article begins with a definition, classi¬
fication, and pathophysiologic description of ARDS. The authors
review the concept of volutrauma in acute lung injury, as well as
the animal and clinical investigations suggesting that appropriate
ventilator settings can minimize this form of exacerbated lung
injury, the best therapies to be considered, and conclude with a
practical bedside approach to these patients.
Metabolic Functions of the Lung 181
Charl de Wet and Jonathan Moss
In addition to their primary function in respiration, the lungs
are important in the metabolism of many biologically important
compounds. Because of the high pulmonary uptake of many
vasoactive compounds, the lungs may acts as a chemical filter to
protect the systemic circulation. The lungs also modulate systemic
vascular tone through the de novo synthesis and activation of
endogenous vasoactive compounds. Furthermore, the pulmonary
circulation displays a high degree of selectivity in its handling of
chemically very similar compounds. Xenobiotics are handled in a
very specific way because of their physiochemical properties and
may display important drug drug interactions of special concern
to the anesthesiologist. The lung emerges as a highly complex
metabolic organ vital to the regulation and maintenance of ho
meostasis.
Cellular Response to Hypoxia 201
Marie Csete
Acute hypoxia is sensed by cells, probably via a heme containing
protein, and a rapid response to hypoxia is initiated at the level
of the gene. A central player in this responses is hypoxia induc
ible factor 1, a transcription factor (HIF 1). (Transcription factor
is the flow of information from DNA to messenger RNA
[mRNA]). HIF 1 binding sites are found in a variety of genes,
and HIF 1 plays a role in up regulating production of these genes
during hypoxia. The targets of HIF 1 include erythropoietin and
glycolytic enzymes.
Current Status of Acid Base Quantitation in Physiology
and Medicine 211
Robert Schlichtig, Alan W. Grogono,
and John W. Severinghaus
Acid base quantitation is a helpful diagnostic tool in acute care,
but neglected by many practitioners because it is so tedious and
CONTENTS ix
controversial. Here we show how to simplify the problem and
reconcile divergent views using standard base excess (SBE), which
we show is entirely consistent with the other currently used
methods: Pco2 vs Hco3, anion gap, and strong ion difference
(SID).
The Pharmacology and Physiology of Nitric Oxide:
Understanding its Use in Anesthesia and Critical Care 235
Margaret Aranda and Ronald G. Pearl
Until 1987, nitric oxide (NO) was viewed as a toxic gas found in
smog and emitted from cigarettes and car exhaust. This article
focuses on the chemistry and pharmacology of NO, its function
in maintaining normal hemostasis, and alteration of NO produc¬
tion in disease states. A review of the clinical applications of
inhaled NO includes ARDS, pulmonary hypertension, and other
special clinical scenarios in which NO may be useful.
Carbon Dioxide Kinetics During Anesthesia:
Pathophysiology and Monitoring 259
Peter H. Breen
Changes in tissue CO2 production, CO2 transfer between the
tissues and lungs by cardiac output, pulmonary CO2 elimination,
and mechanical factors of ventilation can all affect CO2 monitor¬
ing. Consequently, during anesthesia, capnography provides early
detection of critical events, such as esophageal intubation. Newer
measurements are presented, including the CO2 volume exhaled
per breath, the modified Fowler anatomical dead space, the aver¬
age alveolar expired Pco2, and the CO2 spirogram. These mea¬
surements enhance the clinical detection and understanding of
adverse cardiovascular and pulmonary pathophysiology during
non steady state, such as the application of positive end expi¬
ratory pressure.
Anesthesia for the Respiratory Cripple 295
Karen B. Domino
The respiratory cripple presents a challenge for the anesthesiolo¬
gist because of the potential for perioperative hypoxemia, bron
chospasm, postoperative pulmonary complications, and pro¬
longed postoperative mechanical ventilation. In order to avoid
anesthetic disaster, careful preoperative preparation, anesthetic
choice and intraoperative management, and postoperative care
are required. This article reviews the anesthetic risks and periop¬
erative management of patients with severe respiratory disease.
Index 313
Subscription Information Inside back cover
X CONTENTS
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| spelling | Respiration in anesthesia pathophysiology and clinical update Peter H. Breen guest ed. Philadelphia [u.a.] Saunders 1998 XIV, 321 S. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Anesthesiology clinics of North America 16,1 Échanges gazeux pulmonaires Anesthesia Pulmonary Gas Exchange Pulmonary gas exchange Künstliche Beatmung (DE-588)4033439-9 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Künstliche Beatmung (DE-588)4033439-9 s DE-604 Breen, Peter H. Sonstige oth Anesthesiology clinics of North America 16,1 (DE-604)BV000600896 16,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008041892&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
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| title | Respiration in anesthesia pathophysiology and clinical update |
| title_auth | Respiration in anesthesia pathophysiology and clinical update |
| title_exact_search | Respiration in anesthesia pathophysiology and clinical update |
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| title_fullStr | Respiration in anesthesia pathophysiology and clinical update Peter H. Breen guest ed. |
| title_full_unstemmed | Respiration in anesthesia pathophysiology and clinical update Peter H. Breen guest ed. |
| title_short | Respiration in anesthesia |
| title_sort | respiration in anesthesia pathophysiology and clinical update |
| title_sub | pathophysiology and clinical update |
| topic | Échanges gazeux pulmonaires Anesthesia Pulmonary Gas Exchange Pulmonary gas exchange Künstliche Beatmung (DE-588)4033439-9 gnd |
| topic_facet | Échanges gazeux pulmonaires Anesthesia Pulmonary Gas Exchange Pulmonary gas exchange Künstliche Beatmung Aufsatzsammlung |
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