Postoperative Pulmonary Hypoventilation

Müller, George P.; Overholt, Richard H.; Pendergrass, Eugene P.

doi:10.1001/archsurg.1929.01150060384023

Cited by 47 publications

(3 citation statements)

References 14 publications

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“…These have several causes such as alterations in respiratory muscular force, lung volumes and mechanics of breathing, and physiological disturbances of blood gas exchange (CONWAY 1966, NUNN & FREEMAN 1964, NUNN 1966, PETERS 1969, PRYS-ROBERTS et al 1967. Postoperative pain has been suggested as an important factor for these disturbances (BRO-MAGE 1967, MUELLER et al 1929. Pain arising from the thoracic and high abdominal regions can result in shallow breathing, diminished cough ability, retained bronchial secretions and eventually atelectasis.…”

mentioning

confidence: 99%

Respiratory Changes during Continuous Epidural Blockade

Sjögren

Wright

1972

Acta Anaesthesiol Scand

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In 23 otherwise healthy patients a study of respiratory function was carried out during 2 days with continuous epidural blockade in connection with cholecystectomy.Thirteen of the patients received blockade of thoracic extent (TZ-TIZ) and ten of thoraco-lumbar extent (T4-L4).Preokeratively, noteworthy changes were found in the thoracic group, where respiratory muscle force was slightly, and dynamic tests of ventilatory capacity were significantly decreased.Postoperatiuely, a significant but relatively moderate decrease in Paoz (from 86 to 77 mm Hg) was seen in both groups. One hour after surgery P a m , was slightly increased (42 mm Hg) in the thoracic group, but was thereafter in both groups slightly decreased. A significant but moderate metabolic acidosis was present (pH 7.35). On the day after surgery the alveolo-arterial oxygen difference was in the thoracic group significantly increased (from 12 to 25 mm Hg), and so was physiological shunting (from 6 to 12 per cent) with a more pronounced increase a t high values of cardiac output. In both groups, the ventilation-perfusion ratio remained fairly unchanged. Dynamic tests of ventilatory capacity decreased significantly by about 50 per cent. Thoracic inspiratory force decreased more in the thoracic than in the lumbar group. In general, respiration seemed to be more affected under conditions with epidural blockade of thoracic than of thoraco-lumbar extent.

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confidence: 99%

Respiratory Changes during Continuous Epidural Blockade

Sjögren

Wright

1972

Acta Anaesthesiol Scand

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“…is still the most effective therapeutic agent in combating the disease. 4. Prompt isolation of infected patients, preferably in a contagious division or a contagious hospital as soon as the epidemic is recognized, offers the best hope of limiting its spread.…”

Section: Treatmentmentioning

confidence: 99%

Streptococcic Puerperal Sepsis

Swendson¹

1933

JAMA

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“…There were clinical signs of high intracranial 5. Coleman, C. C. : The Treatment of Abscess of the Brain, Arch.…”

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Brain Abscess

Coleman¹

1930

JAMA

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Newburgh and Marsh, have been used since 1918. The aim is to furnish a diet containing a sufficient number of calories to maintain the individual following his usual occupation at approximately 10 per cent less than the standard weight for age, sex and height. We consider the diet as maintenance only when the weight is maintained at the desired level with the patient performing his usual work and activity. In review¬ ing 1,520 cases treated over a period of seven years, I found that the average caloric value of the diet necessary for main¬ tenance was 2,500 calories. It may be possible to maintain an individual's weight on a diet lower in calories, but in order to do so the activity must be diminished ; and Dr. Bowen has pointed out in his cases that "when the occupations were com¬ pared, it was found that all except two of those who felt no fatigue had sedentary occupations." I take it that this group maintained their weight. The diet as a source of energy must therefore fulfil two requirements to maintain the desired weight and to maintain strength to perform the usual activity. On the other hand, if the patient is overweight, the caloric intake is limited and the patient must use his body fat as a source of energy until a desired weight level is reached. The carbohydrate content of our diets averages 65 Gm. The aver¬ age, amount of fat used is 220 Gm. and the protein averages 60 Gm. The available dextrose content of these diets averages 125 Gm. and the fatty acid dextrose ratio is 2.0. Dr. Bowen has pointed out that many of his patients who became fatigued easily experienced insulin reactions during exercise and that a disturbance of mental acuity occurred frequently during these reactions. May there not have been a certain number who had the sense of fatigability and a disturbance of mental activity due to a hypoglycemia, the result, of too much insulin, which was not severe enough to manifest definite clinical symptoms? In our series of 1,520 cases, insulin was used in only 361, or 23.7 per cent. Forty per cent of the patients had a tolerance not above 125 Gm. of dextrose and yet were able to take a maintenance diet without the aid of insulin. Had these 40 per cent been given a maintenance diet with a higher carbohydrate content, they would all have required insulin. dealt with the subject of the economic status of diabetic patients and refers especially to the benefit derived from insulin. I will report a case in which insulin almost proved fatal. The patient was a young man, a real estate agent, with a moderately severe diabetes. He had been under the treatment of some good clinicians who had prescribed a definite diet and insulin. He progressed well until he began to have convulsions early every evening. The attending physician called a neurologist in con¬ sultation. They decided that the young man was having epi¬ leptic seizures. He had to give up his occupation. It was dangerous for him to drive his car. They asked me to see him. I told him it was no use to see him until he had one of his seizures. One ...

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Postoperative Pulmonary Hypoventilation

Cited by 47 publications

References 14 publications

Respiratory Changes during Continuous Epidural Blockade

Respiratory Changes during Continuous Epidural Blockade

Streptococcic Puerperal Sepsis

Brain Abscess

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