Abstract:
BACKGROUND:Experimental and clinical studies have shown reduction in intrapulmonary shunt with improved oxygenation by spontaneous breathing with airway pressure release ventilation (APRV) in acute lung injury. The mechanisms of these findings are not clear. The authors hypothesized that spontaneous breathing results in better aeration of lung tissue and that improvement in oxygenation can be explained by these changes. This hypothesis was studied in a porcine model of oleic acid-induced lung injury. METHODS:Two hours after induction of lung injury, 24 pigs were randomly assigned to APRV with or without spontaneous breathing at a positive end-expiratory pressure of 5 cm H(2)O. Hemodynamics, spirometry, and end-expiratory lung volume by nitrogen washout were measured at baseline, after 2 h of lung injury, and after 2 and 4 h of mechanical ventilation in the specific mode. Finally, spiral computed tomography of the chest was performed at end-expiratory lung volume in 22 pigs. RESULTS:Arterial carbon dioxide tension and mean and end-inspiratory airway pressures were comparable between settings. Four hours of APRV with spontaneous breathing resulted in improved oxygenation compared with APRV without spontaneous breathing (arterial oxygen tension, 144 +/- 65 vs. 91 +/- 50 mmHg, P < 0.01 for interaction time x mode), higher end-expiratory lung volume (786 +/- 320 vs. 384 +/- 148 ml, P < 0.001), and better aeration. End-expiratory lung volume and venous admixture were both correlated with the amount of lung reaeration (r(2) = 0.62 and r(2) = 0.61, respectively). CONCLUSIONS:The results support the hypothesis that spontaneous breathing during APRV improves oxygenation mainly by recruitment of nonaerated lung and improved aeration of the lungs.
journal_name
Anesthesiologyjournal_title
Anesthesiologyauthors
Wrigge H,Zinserling J,Neumann P,Defosse J,Magnusson A,Putensen C,Hedenstierna Gdoi
10.1097/00000542-200308000-00019subject
Has Abstractpub_date
2003-08-01 00:00:00pages
376-84issue
2eissn
0003-3022issn
1528-1175pii
00000542-200308000-00019journal_volume
99pub_type
杂志文章相关文献
ANESTHESIOLOGY文献大全abstract:BACKGROUND:The value of exercise electrocardiography in the prediction of perioperative cardiac risk has yet to be defined. This study was performed to determine the predictive value of exercise electrocardiography as compared with clinical parameters and resting electrocardiography. METHODS:A total of 204 patients at...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200101000-00011
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:The probability of recovering consciousness in acute brain-injured patients depends on central nervous system damage and complications acquired during their stay in the intensive care unit. The objective of this study was to establish a relation between the Bispectral Index (BIS) and other variables derived ...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章
doi:10.1097/00000542-200407000-00009
更新日期:2004-07-01 00:00:00
abstract:BACKGROUND:Acid-sensing ion channel 3 (ASIC3) upregulation has been reported in dorsal root ganglion neurons after incision and contributes to postoperative nociception. This study hypothesized that upregulation of ASIC3 in incised tissues is induced by nerve growth factor through the phosphoinositide 3-kinase/protein ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0000000000003576
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Malignant hyperthermia is associated with mutations within the gene encoding the skeletal muscle ryanodine receptor, the calcium channel that releases Ca from sarcoplasmic reticulum stores triggering muscle contraction, and other metabolic activities. More than 200 variants have been identified in the ryanod...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e3181d69283
更新日期:2010-06-01 00:00:00
abstract::The authors performed a randomized, prospective trial comparing enflurane, halothane, and isoflurane (each administered with nitrous oxide) to establish which inhaled anesthetic produced the fewest complications and the most rapid induction of anesthesia for children undergoing general anesthesia for diagnostic proced...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-198512000-00015
更新日期:1985-12-01 00:00:00
abstract:BACKGROUND:The tuberomammillary histaminergic neurons are involved in the sedative component of anesthetic action. The nucleus basalis magnocellularis (NBM) in the basal forebrain receives dense excitatory innervation from the tuberomammillary nucleus and is recognized as an important site of sleep-wake regulation. Thi...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e3181b061a0
更新日期:2009-10-01 00:00:00
abstract::To evaluate the effect of aging on the distribution, metabolism, and neuromuscular junction sensitivity to pancuronium and vecuronium, the authors determined the pharmacokinetics and pharmacodynamics of these drugs in 12 healthy elderly subjects (70-84 yr) and 12 young adults (30-57 yr) during halothane-nitrous oxide ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198707000-00008
更新日期:1987-07-01 00:00:00
abstract:BACKGROUND:In standard textbooks, intravenous lidocaine is recommended for intubation of patients with bronchial hyperreactivity. However, whether and to what extent intravenous local anesthetics attenuate bronchial hyperreactivity in humans is unknown. Accordingly, nine awake volunteers with known bronchial hyperreact...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-199603000-00007
更新日期:1996-03-01 00:00:00
abstract:BACKGROUND:The analgesic efficacy and side effect profile of intravenous parecoxib, a novel cyclooxygenase type-2 (COX-2) inhibitor, was assessed in a double-blinded, placebo-controlled study involving patients undergoing major gynecologic surgical procedures. METHODS:After Institutional Review Board approval, 60 cons...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-200206000-00007
更新日期:2002-06-01 00:00:00
abstract::This study was designed to test the hypothesis that the volatile anesthetics directly affect cardiac contractile proteins. For this purpose, the effects of various anesthetic doses of halothane, enflurane, and isoflurane on myocardial calcium sensitivity and maximal calcium-activated force were examined in rat cardiac...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198812000-00015
更新日期:1988-12-01 00:00:00
abstract:BACKGROUND:Preoperative anemia is frequent in patients undergoing orthopedic surgery. The purpose of this study was to assess the preoperative increase of hemoglobin in iron deficiency anemia patients treated with intravenous iron. METHODS:After obtaining written informed consent, 20 patients with iron deficiency anem...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/01.anes.0000291441.10704.82
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND:Mutations in the methylenetetrahydrofolate reductase (MTHFR) gene (677C>T, 1298A>C) cause elevated plasma homocysteine concentrations and have been linked to fatal outcomes after nitrous oxide anesthesia. This study tested the hypothesis that patients with common MTHFR 677C>T or 1298A>C mutations develop hig...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e318178820b
更新日期:2008-07-01 00:00:00
abstract:BACKGROUND:Dexmedetomidine is a sedative with modest analgesic efficacy, whereas remifentanil is an opioid analgesic with modest sedative potency. Synergy is often observed when sedative-hypnotics are combined with opioid analgesics in anesthetic practice. A three-phase crossover trial was conducted to study the pharma...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章
doi:10.1097/ALN.0000000000002882
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Postoperative cognitive dysfunction is common, but it remains unclear whether there are long-term adverse cognitive effects of surgery combined with anesthesia. The authors examined the association between exposure to surgery and level of cognitive functioning in a sample of 8,503 middle-aged and elderly twi...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0000000000000957
更新日期:2016-02-01 00:00:00
abstract:BACKGROUND:Patients who are homozygous for the atypical mutation, compound heterozygous for atypical and silent mutations, or homozygous for silent mutations (SS) respond to mivacurium with extensively prolonged neuromuscular block. Although important, exact phenotyping of these patients is difficult. This article pres...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200109000-00010
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:Nonimmobilizers are agents that lack anesthetic properties, although their chemical structure is very similar to known anesthetics. The primary action site of both agents, whether at the membrane or target protein level, is still a matter of debate. However, increasing evidence points to the distinct modific...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200210000-00016
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:The pharmacology of oxycodone is poorly understood despite its growing clinical use. The discrepancy between its good clinical effectiveness after systemic administration and the loss of potency after spinal administration led the authors to study the pharmacodynamic effects of oxycodone and its metabolites ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200610000-00027
更新日期:2006-10-01 00:00:00
abstract::The authors undertook a prospective study of 30 patients undergoing halothane anesthesia for coronary-artery revascularization to ascertain which clinically monitored hemodynamic variables--or combination of variables--associated with myocardial oxygen supply and demand best predict myocardial ischemia. Simultaneous r...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198307000-00007
更新日期:1983-07-01 00:00:00
abstract:BACKGROUND:Anesthetic preconditioning (APC) with sevoflurane reduces myocardial ischemia-reperfusion injury. The authors tested whether two brief exposures to sevoflurane would lead to a better preconditioning state than would a single longer exposure and whether dual exposure to a lower (L) concentration of sevofluran...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200403000-00016
更新日期:2004-03-01 00:00:00
abstract:BACKGROUND:The tube of the intubating laryngeal mask (ILM) is more rigid than the standard laryngeal mask airway (LMA), and the authors have tested the hypothesis that pharyngeal mucosal pressures, airway sealing pressures, and fiberoptic position are different when the two devices are compared. METHODS:Twenty anesthe...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-199904000-00012
更新日期:1999-04-01 00:00:00
abstract::The occurrence of fasciculations following administration of agents is a well-known pharmacologic phenomenon. Using the cat soleus nerve-muscle preparation, intravenous neostigmine doses between 20-200 micrograms/kg evoked fasciculations in a dose-related manner. The data demonstrate that the fasciculations were the r...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198712000-00011
更新日期:1987-12-01 00:00:00
abstract::The effect of halothane, at clinically relevant concentrations on the ability of human polymorphonuclear leukocytes (PMNL) to kill the most frequently isolated gram-negative organisms responsible for human bacteremias, Escherichia coli and Klebsiella pneumoniae, was studied. Exposure of PMNL to 0.75 per cent halothane...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-198155060-00009
更新日期:1981-12-01 00:00:00
abstract:BACKGROUND:Ketamine is an anesthetic drug. Subanesthetic doses of ketamine have been shown to reduce interleukin-6 concentrations after surgery and to reduce mortality and the production of tumor necrosis factor alpha and interleukin 6 in septic animals. Similarly, adenosine was shown to reduce tumor necrosis factor al...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200506000-00017
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:Mild hypothermia is accompanied by metabolic changes. Epidural local anesthetic agents attenuate the surgical stress response, but it is not known whether they modulate thermal stress. METHODS:Thirty patients undergoing colorectal surgery, performed by one surgical team, received epidural 0.5% bupivacaine t...
journal_title:Anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00000542-199805000-00011
更新日期:1998-05-01 00:00:00
abstract:BACKGROUND:Serious complications related to regional anesthesia have previously been described primarily in case reports and retrospective surveys. The authors prospectively evaluated a multicenter series of regional anesthetics, using preplanned criteria to measure the incidence and characteristics of associated serio...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199709000-00005
更新日期:1997-09-01 00:00:00
abstract:BACKGROUND:Excessive intraoperative bleeding is associated with significant morbidity and mortality. The authors and others have shown that fibrin monomer allows preoperative risk stratification for intraoperative blood loss, likely due to an imbalance between available factor XIII and prothrombin conversion. The autho...
journal_title:Anesthesiology
pub_type: 杂志文章,随机对照试验
doi:10.1097/ALN.0b013e318194b21e
更新日期:2009-02-01 00:00:00
abstract:BACKGROUND:The distribution and elimination of 0.9% saline given by intravenous infusion has not been compared between the conscious state and during inhalational anesthesia. METHODS:Six adult sheep received an intravenous infusion of 25 ml/kg of 0.9% saline over 20 min in the conscious state and also during isofluran...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-200202000-00033
更新日期:2002-02-01 00:00:00
abstract:BACKGROUND:The spinal cord appears to be the site at which isoflurane suppresses movement that occurs in response to a noxious stimulus. In an attempt to localize its site of suppressant action, the authors determined the effect of isoflurane on dorsal horn neuronal responses to supramaximal noxious stimulation at end-...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-199901000-00027
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND:The Bispectral Index (BIS) and the Patient State Index (PSI) quantify depth of anesthesia by analyzing the electroencephalogram. The authors examined the response of BIS and PSI to sevoflurane anesthesia. METHODS:In 22 patients, sevoflurane anesthesia was induced by inhalation with a tight-fitting facemask ...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/ALN.0b013e3181895fd0
更新日期:2008-11-01 00:00:00
abstract::Four volunteers judged eight levels of thermal stimuli induced by a Hardy dolorimeter, varying in intensity from extremely painful to a low level seldom even perceived. Half of the 406 stimuli were applied during acupuncture and half either before insertion or after removal of the needles. The experimental design mini...
journal_title:Anesthesiology
pub_type: 杂志文章
doi:10.1097/00000542-197511000-00005
更新日期:1975-11-01 00:00:00