Summa yUsing a respiratory inductive plethysmograph, we investigated the effects of halothane and sevoflurane on the paediatric respiratory pattern under spontaneous breathing. We measured tidal volume per weight, respiratory rate, partial pressure of end-expiratory carbon dioxide (PetCo2), rib cage contribution to ventilation (%RC) and phase shift between rib cage and abdominal movements at 0.5, 1.0 and 1.5 MAC of these inhalational anaesthetics in oxygen. Both of these anaesthetics increased Petco, significantly with increase in depth of anaesthesia; sevoflurane produced more profound respiratory depression than halothane at high MAC. Both agents decreased %RC significantly with increase in depth of anaesthesia; paradoxical respiration occurred in the halothane group at high MAC. The profound respiratory depression of sevoflurane is due to both decreased tidal volume and decreased respiratory rate. The paradoxical respiration under halothane may be attributed to the potent suppression of intercostal muscle function and may be partly due to compensatory sparing effect on respiratory rate, which leads to the increase in airway flow and airway resistance.
Purpose: To compare the effectiveness of three patient-triggered ventilators by evaluating triggering delay time and pressure-volume loops during initiation of inspiration. Methods: In a two-part study, a model lung was used in part I and 20 children, after tracheal intubation, in part 2. Triggering delay time and work of breathing 0AIOB) during pressure support ventilation using three patient-triggered ventilators: Servo Ventilator 300 TM VIP Bird", and SLE 2000 Neonatal Ventilator TM. Triggering delay time was from the beginning of negative deflection in the oesophage~ pressure trace, to the onset of inspiration. The WOB was estimated directly by measuring the oesophageal pressure-volume loop. Objectif: Comparer l'efficacit~ de trois respirateurs d&lench& par le patient en ~valuant le d~lai et les courbes pression-volume durant la phase initiale de l'inspiration. M&hodes : Dans cette ~tude en 2 volets, un module pulrnonaire a ~t~ utilis~ pour la premi&e pattie et 20 enfants intub~s pour la deuxi~me. On a ~tudi~ le d~lai de d&lenchement de l'appareil et le travail respiratoire (-l-R) durant la ventilation selon le mode pression de support en utilisant trois respirateurs d&lench& par le patient : le ventilateur Servo 300@, le Bird VIP@ et le SLE 2000 Neonatal Ventilator~. Le d~lal de d~clenchement de l'appareil a ~t~ calcul~ ~ partit du d~but de la d~fection n~gative sur le trac~ de pression oesophagienne jusqu'au d~but de rinspiration. Le TR a ~t~ estim~ directement en mesurant la boucle pression-volume oesophagienne. RA.suitats : Le Servo a d~montrE un meilleur d~lai de d&lenchement et un TR rEduit darts l'&ude utilisant le module pulmonaire. Le Bird VIP a d~montr~ un d~lai plus court et un TR diminu~ darts la partie clinique de l'~tude. Dans le module pulmonaire, le d~lai de d&lenchement du Servo 300 (62 ___ 6 msec (moyenne + &art type)) a ~t~ plus court que celui du Bird VIP (76 • 7 msec) (P<0,05), et le TR avec le SLE 2000 (202 ___ 37 g.cm) a ~t~ plus grand qu'avec les deux autres ventilateurs (Servo 300, 112 ___ 32 g'cm et Bird VIP 72 • 41 g'cm) (P<0,05), Darts la partie clinique de r&ude, le d~lai de d&lenchement du Bird VIP (52 ___ 19 msec) a ~t~ plus court qu'avec les autres ventilateurs, Servo 300 (66 ---14 msec) et SLE 2000 (68 • 65 msec) (P<0,05). Le TR du Servo 300 (56 • 34 g.cm) a ~t~ plus ~lev~ que celui des deux autres ventilateurs : Bird VIP (22 ___ 12 g-cm) et SLE 2000 (14 ___ 3 g-cm) (P<0,05). Conclusion : La performance de ces ventilateurs dans le modEle pulmonaire ne correspond pas ~ leur performance clinique. Au cours de notre ~valuation clinique, le Bird VIP a d6montr6 une performance sup&ieure aux autres avec un d61ai de dEclenchement moindre, un faible TR pour initier l'inspiration et peu de fuite5 d'air.
Low-flow anesthesia is less effective in providing adequate humidification of inspired gas than low-flow anesthesia with a heat and moisture exchanger, but significantly better than high-flow anesthesia in children.
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