Pulmonary blood flow redistribution with low levels of positive end-expiratory pressure.

Abstract:

BACKGROUND:Recent studies have questioned the importance of the gravitational model of pulmonary perfusion. Because low levels of positive end-expiratory pressure (PEEP) are commonly used during anesthesia, the authors studied the distribution of pulmonary blood flow with low levels of PEEP using a high spatial resolution technique. They hypothesized that if hydrostatic factors were important in the distribution of pulmonary blood flow, PEEP would redistribute flow to more dependent lung regions. METHODS:The effects of zero cm H2O PEEP and 5 cm H2O PEEP on pulmonary gas exchange were studied using the multiple inert gas elimination technique; the distribution of pulmonary blood flow, using fluorescent-labeled microspheres, was also investigated in mechanically ventilated, pentobarbital-anesthetized dogs. The lungs were removed, cleared of blood, dried at total lung capacity, and then cubed to obtain approximately 1,000 small pieces of lung (approximately 1.7 cm3). RESULTS:Positive end-expiratory pressure increased the partial pressure of oxygen by 6 +/- 2 mmHg (P < 0.05) and reduced all measures of ventilation and perfusion heterogeneity (P < 0.05). By reducing flow to nondependent ventral lung regions and increasing flow to dependent dorsal lung regions, PEEP increased (P < 0.05) the dorsal-to-ventral gradient. Redistribution of blood flow with PEEP accounted for 7 +/- 3%, whereas structural factors accounted for 93 +/- 3% of the total variance in blood flow. CONCLUSIONS:The increase in dependent-to-nondependent gradient with PEEP is partially consistent with the gravitationally based lung zone model. However, the results emphasize the greater importance of anatomic factors in determining the distribution of pulmonary blood flow.

journal_name

Anesthesiology

journal_title

Anesthesiology

authors

Kallas HJ,Domino KB,Glenny RW,Anderson EA,Hlastala MP

doi

10.1097/00000542-199805000-00021

subject

Has Abstract

pub_date

1998-05-01 00:00:00

pages

1291-9

issue

5

eissn

0003-3022

issn

1528-1175

journal_volume

88

pub_type

杂志文章
  • Porcine malignant hyperthermia: effects of halothane on mitochondrial respiration and calcium accumulation.

    abstract::Vastus lateralis muscle was excised from normal pigs and from pigs susceptible to malignant hyperthermia. Anesthesia consisted of diazepam, N2O:O2, and a lidocaine field block. In the susceptible (MHS) pigs, respiratory control in mitochondria of excised muscle was normal, while electron transport was accelerated. Glu...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:

    authors: Britt BA,Endrenyi L,Cadman DL,Fan HM,Fung HY

    更新日期:1975-03-01 00:00:00

  • A Practical Training Program for Peripheral Radial Artery Catheterization in Adult Patients: A Prospective, Randomized Controlled Trial.

    abstract:BACKGROUND:The main cause of unsuccessful peripheral radial artery catheterization using traditional palpation is imprecisely locating the arterial center. The authors evaluated factors causing disparities between the arterial centers determined by palpation versus ultrasound. The authors applied them to create and tes...

    journal_title:Anesthesiology

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/ALN.0000000000001263

    authors: Nakayama Y,Inagaki Y,Nakajima Y,Sessler DI,Mukai N,Ogawa S,Mizobe T,Sawa T

    更新日期:2016-10-01 00:00:00

  • New ultrathin-walled endotracheal tube with a novel laryngeal seal design. Long-term evaluation in sheep.

    abstract:BACKGROUND:A new endotracheal tube (ETT) was fabricated and tested in sheep. It had no tracheal cuff; airway seal was achieved at the level of the glottis through a no-pressure seal made of "gills"; the laryngeal portion was oval-shaped; and the wall thickness was reduced to 0.2 mm. METHODS:Sheep were tracheally intub...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199601000-00019

    authors: Reali-Forster C,Kolobow T,Giacomini M,Hayashi T,Horiba K,Ferrans VJ

    更新日期:1996-01-01 00:00:00

  • Induction of malignant hyperthermia in susceptible swine by 3,4-methylenedioxymethamphetamine ("ecstasy").

    abstract:BACKGROUND:3,4-Methylenedioxymethamphetamine (MDMA, "ecstasy") can mediate acute toxic effects such as muscle rigidity, metabolic acidosis, and hyperthermia. Because of close clinical similarities, an association between MDMA intoxication and malignant hyperthermia (MH) was suggested. The aim of this study was to inves...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200311000-00020

    authors: Fiege M,Wappler F,Weisshorn R,Gerbershagen MU,Menge M,Schulte Am Esch J

    更新日期:2003-11-01 00:00:00

  • Double-blind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting.

    abstract:BACKGROUND:Breast surgery is associated with a high incidence of postoperative nausea and vomiting. Propofol and prophylactic administration of ondansetron are associated with a lower incidence of postoperative nausea and vomiting. To date no comparison of these two drugs has been reported. A randomized study was done ...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-199611000-00011

    authors: Gan TJ,Ginsberg B,Grant AP,Glass PS

    更新日期:1996-11-01 00:00:00

  • Differential effects of inhalation anesthetics on myocardial potentiated-state contractions in vitro.

    abstract::The effects of enflurane, halothane, and isoflurane on myocardial potentiated-state contractions were examined in a study in which each of the anesthetics was presented, in random order, to each of eight isolated rabbit papillary muscles. Post-rest potentiated-state contractions were elicited by imposing a stimulus at...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198804000-00010

    authors: DeTraglia MC,Komai H,Rusy BF

    更新日期:1988-04-01 00:00:00

  • Midazolam: effects on amnesia and anxiety in children.

    abstract:BACKGROUND:The minimum time interval between administration of oral midazolam and separation of children from their parents that ensures good anterograde amnesia has not been previously determined. This is of particular importance in a busy operating room setting where schedule delays secondary to midazolam administrat...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00000542-200009000-00016

    authors: Kain ZN,Hofstadter MB,Mayes LC,Krivutza DM,Alexander G,Wang SM,Reznick JS

    更新日期:2000-09-01 00:00:00

  • Substance Use Disorder in Physicians after Completion of Training in Anesthesiology in the United States from 1977 to 2013.

    abstract:BACKGROUND:Substance use disorder among physicians can expose both physicians and their patients to significant risk. Data regarding the epidemiology and outcomes of physician substance use disorder are scarce but could guide policy formulation and individual treatment decisions. This article describes the incidence an...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000003310

    authors: Warner DO,Berge K,Sun H,Harman A,Wang T

    更新日期:2020-08-01 00:00:00

  • Toll-like receptor 4-myeloid differentiation factor 88 signaling contributes to ventilator-induced lung injury in mice.

    abstract:BACKGROUND:The mechanisms of ventilator-induced lung injury, an iatrogenic inflammatory condition induced by mechanical ventilation, are not completely understood. Toll-like receptor 4 (TLR4) signaling via the adaptor protein myeloid differentiation factor 88 (MyD88) is proinflammatory and plays a critical role in host...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3181e89ab2

    authors: Li H,Su X,Yan X,Wasserloos K,Chao W,Kaynar AM,Liu ZQ,Leikauf GD,Pitt BR,Zhang LM

    更新日期:2010-09-01 00:00:00

  • Interaction of halothane with alpha- and beta-adrenoceptor stimulations in rat myocardium.

    abstract:BACKGROUND:Halothane induces negative inotropic and lusitropic effects in myocardium. It has been suggested that halothane potentiates beta-adrenoceptor stimulation. However, its effects on the inotropic response to alpha-adrenoceptor stimulation and its effects on the lusitropic effects of alpha- and beta-adrenoceptor...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199701000-00019

    authors: Hanouz JL,Riou B,Massias L,Lecarpentier Y,Coriat P

    更新日期:1997-01-01 00:00:00

  • 5-HT1A receptor agonist Befiradol reduces fentanyl-induced respiratory depression, analgesia, and sedation in rats.

    abstract:BACKGROUND:There is an unmet clinical need to develop a pharmacological therapy to counter opioid-induced respiratory depression without interfering with analgesia or behavior. Several studies have demonstrated that 5-HT1A receptor agonists alleviate opioid-induced respiratory depression in rodent models. However, ther...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0000000000000490

    authors: Ren J,Ding X,Greer JJ

    更新日期:2015-02-01 00:00:00

  • Internal carotid artery stump pressure and cerebral blood flow during carotid endarterectomy: modification by halothane, enflurane, and innovar.

    abstract::Carotid endarterectomy requires temporary surgical occlusion of the involved carotid artery. During occlusion, the minimally acceptable (critical) internal carotid artery stump pressure is reported to be 50 torr, whereas for regional cerebral blood flow (rCBF), a critical range is reported to be 18-24 ml/100 g/min. Du...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-197610000-00007

    authors: McKay RD,Sundt TM,Michenfelder JD,Gronert GA,Messick JM,Sharbrough FW,Piepgras DG

    更新日期:1976-10-01 00:00:00

  • Vecuronium neuromuscular blockade reflects liver function during hepatic autotransplantation in pigs.

    abstract:BACKGROUND:Rapid assessment of hepatic function early after reperfusion of the liver graft is of great importance, because it may allow for prompt detection of incipient hepatic graft failure. The current study was undertaken to determine whether the continuous recording of neuromuscular transmission could be used as a...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199407000-00023

    authors: Pittet JF,Morel DR,Mentha G,Schopfer C,Belenger J,Benakis A,Tassonyi E

    更新日期:1994-07-01 00:00:00

  • Effect of Bay K 8644 on the magnitude of isoflurane and halothane contracture of skeletal muscle from patients susceptible to malignant hyperthermia.

    abstract::Isoflurane has a lesser ability than halothane to induce contracture in malignant hyperthermia (MH) muscle in vitro. This does not necessarily imply that isoflurane is not as potent an MH trigger as halothane in vivo. A hypothesis was tested that in vitro treatment with Bay K 8644, an activator of both the dihydropyri...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199204000-00010

    authors: Adnet PJ,Krivosic-Horber RM,Adamantidis MM,Haudecoeur G,Reyford H,Imbenotte M

    更新日期:1992-04-01 00:00:00

  • Changes in lung volume and lung-thorax compliance during cardiac surgery in children 11 days to 4 years of age.

    abstract::To examine the effects of cardiac surgery and cardiopulmonary bypass (CPB) on the lung, functional residual capacity (FRC) and lung-thorax compliance were measured at four stages during open heart surgery in 15 children. The patients were anesthetized with fentanyl/droperidol and N2O/O2, paralyzed, and ventilated with...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:

    authors: Jonmarker C,Larsson A,Werner O

    更新日期:1986-09-01 00:00:00

  • Relationship of train-of-four ratio to twitch depression during pancuronium-induced neuromuscular blockade.

    abstract::The relationship of train-of-four (TOF) ratio to the depression of the first twitch (TD) was investigated in 16 patients given pancuronium in doses insufficient to eliminate the fourth response in the train. In ten patients the block was allowed to spontaneously recover (Group 1) and in six it was reversed with neosti...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198612000-00003

    authors: Graham GG,Morris R,Pybus DA,Torda TA,Woodey R

    更新日期:1986-12-01 00:00:00

  • Effect of hemorrhage and hypotension on transcranial motor-evoked potentials in swine.

    abstract:BACKGROUND:Transcranial motor-evoked potentials (TcMEPs) monitor spinal cord motor tract integrity. Using a swine model, the authors studied the effects of vasodilatory hypotension, hemorrhage, and various resuscitation efforts on TcMEP responses. METHODS:Twelve pigs were anesthetized with constant infusions of propof...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e31829d4a92

    authors: Lieberman JA,Feiner J,Lyon R,Rollins MD

    更新日期:2013-11-01 00:00:00

  • Isoflurane and nociception: spinal alpha2A adrenoceptors mediate antinociception while supraspinal alpha1 adrenoceptors mediate pronociception.

    abstract:BACKGROUND:The authors recently established that the analgesic actions of the inhalation anesthetic nitrous oxide were mediated by noradrenergic bulbospinal neurons and spinal alpha2B adrenoceptors. They now determined whether noradrenergic brainstem nuclei and descending spinal pathways are responsible for the antinoc...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200202000-00023

    authors: Kingery WS,Agashe GS,Guo TZ,Sawamura S,Davies MF,Clark JD,Kobilka BK,Maze M

    更新日期:2002-02-01 00:00:00

  • Lower isoflurane concentration affects spatial learning and neurodegeneration in adult mice compared with higher concentrations.

    abstract:BACKGROUND:Volatile anesthetics such as isoflurane are widely used in clinical and research contexts. Concerns have been raised that the effects of these drugs on the central nervous system may result in long-term impairment after surgery or general anesthesia. Hence, this study aimed to detect how different isoflurane...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e3181f79c7c

    authors: Valentim AM,Di Giminiani P,Ribeiro PO,Rodrigues P,Olsson IA,Antunes LM

    更新日期:2010-11-01 00:00:00

  • Metabolism of ketamine stereoisomers by human liver microsomes.

    abstract::Ketamine is used clinically as a racemic mixture of optical isomers that differ in their analgesic properties and psychomimetic effects. Administered individually, or together as the racemate, ketamine enantiomers differ in their hepatic clearance and duration of anesthetic effect. S(+) ketamine exhibits a greater cle...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199212000-00022

    authors: Kharasch ED,Labroo R

    更新日期:1992-12-01 00:00:00

  • Isoflurane anesthesia and circadian temperature cycles in humans.

    abstract::Cognitive performance in postsurgical patients may be impaired by disturbances of normal circadian rhythm analogous to those produced by rapid transmeridian travel ("jet lag"). We therefore tested the hypothesis that isoflurane anesthesia alone produces a phase-delay in the human circadian temperature rhythm. We monit...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199112000-00010

    authors: Sessler DI,Lee KA,McGuire J

    更新日期:1991-12-01 00:00:00

  • Preoperative pain sensitivity and its correlation with postoperative pain and analgesic consumption: a qualitative systematic review.

    abstract::Pain perception to minor physical stimuli has been hypothesized to be related to subsequent pain ratings after surgery. The objective of this systematic review was to evaluate the correlation between preoperative pain sensitivity and postoperative pain intensity. After a literature search of MEDLINE, EMBASE, and meeti...

    journal_title:Anesthesiology

    pub_type: 杂志文章,评审

    doi:10.1097/ALN.0b013e3181f85ed2

    authors: Abrishami A,Chan J,Chung F,Wong J

    更新日期:2011-02-01 00:00:00

  • Spinal muscarinic and nicotinic subtypes activated by clonidine in postincisional pain.

    abstract:BACKGROUND:A recent model of acute incisional pain has been characterized that strongly parallels the postoperative period in patients experiencing evoked pain. In that setting, abundant literature has revealed antihypersensitive effects produced by intrathecally administered alpha2-adrenergic receptor agonists, such a...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200512000-00022

    authors: Duflo F,Boselli E,Ryvlin P,Chassard D

    更新日期:2005-12-01 00:00:00

  • Performance of noninvasive partial CO2 rebreathing cardiac output and continuous thermodilution cardiac output in patients undergoing aortic reconstruction surgery.

    abstract:BACKGROUND:In the partial CO(2) rebreathing method, monitored changes in CO(2) elimination and end-tidal CO(2) in response to a brief rebreathing period are used to estimate cardiac output. However, dynamic changes in CO(2) production during ischemia and reperfusion may affect the accuracy of these estimates. This stud...

    journal_title:Anesthesiology

    pub_type: 临床试验,杂志文章

    doi:10.1097/00000542-200308000-00009

    authors: Kotake Y,Moriyama K,Innami Y,Shimizu H,Ueda T,Morisaki H,Takeda J

    更新日期:2003-08-01 00:00:00

  • Prognostic significance of blood lactate and lactate clearance in trauma patients.

    abstract:BACKGROUND:Lactate has been shown to be a prognostic biomarker in trauma. Although lactate clearance has already been proposed as an intermediate endpoint in randomized trials, its precise role in trauma patients remains to be determined. METHODS:Blood lactate levels and lactate clearance (LC) were calculated at admis...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/ALN.0b013e318273349d

    authors: Régnier MA,Raux M,Le Manach Y,Asencio Y,Gaillard J,Devilliers C,Langeron O,Riou B

    更新日期:2012-12-01 00:00:00

  • Primer of postoperative pruritus for anesthesiologists.

    abstract::Postoperative itching is an important problem in the postoperative care unit. Pruritus after surgery may be drug induced (including intrathecal opioids) or secondary to a preexisting systemic disease. Mechanisms of itching are complex and not completely understood. The purpose of this review is to highlight new discov...

    journal_title:Anesthesiology

    pub_type: 杂志文章,评审

    doi:10.1097/00000542-200507000-00025

    authors: Waxler B,Dadabhoy ZP,Stojiljkovic L,Rabito SF

    更新日期:2005-07-01 00:00:00

  • Thiopental treatment after global brain ischemia in pigtailed monkeys.

    abstract::The authors investigated the value of high-dose thiopental (TH) therapy after 16-min complete global brain ischemia (GBI) in three groups of pigtailed monkeys, using a neck cuff model of GBI with 96 h intensive care postischemia (PI). Control group (n18): Normotension was restored within 2 min PI; paralysis/controlled...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198402000-00002

    authors: Gisvold SE,Safar P,Hendrickx HH,Rao G,Moossy J,Alexander H

    更新日期:1984-02-01 00:00:00

  • Evaluation of low-dose endotoxin administration during pregnancy as a model of preeclampsia.

    abstract:BACKGROUND:Recent evidence implicates nitric oxide (*NO) in the pathogenesis of preeclampsia. The authors tested the hypothesis that administration of low-dose endotoxin to pregnant rats mimics the signs of preeclampsia in humans and that *NO and *NO-derived species play a role in that animal model. METHODS:Endotoxin ...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-200012000-00017

    authors: Sakawi Y,Tarpey M,Chen YF,Calhoun DA,Connor MG,Chestnut DH,Parks DA

    更新日期:2000-12-01 00:00:00

  • Local cerebral blood flow during lidocaine-induced seizures in rats.

    abstract::Neurophysiologic and local cerebral metabolic mapping techniques indicate that seizures associated with lidocaine toxicity originate in subcortical brain structures. Normally local cerebral blood flow (l-CBF) is quantitatively coupled to local cerebral metabolic rate for glucose (l-CMRg). In the present study the resp...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-198606000-00016

    authors: Tommasino C,Maekawa T,Shapiro HM

    更新日期:1986-06-01 00:00:00

  • A comparison of obstetric and nonobstetric anesthesia malpractice claims.

    abstract::Malpractice claims filed against anesthesiologists for care involving obstetric (OB) anesthesia (n = 190) were taken from the American Society of Anesthesiologists' Closed Claims Database and compared to claims not involving OB cases (n = 1351). The most common complications in the OB claims were (percentage of all OB...

    journal_title:Anesthesiology

    pub_type: 杂志文章

    doi:10.1097/00000542-199102000-00009

    authors: Chadwick HS,Posner K,Caplan RA,Ward RJ,Cheney FW

    更新日期:1991-02-01 00:00:00