RESUMEN

BACKGROUND: Refractory Ceramic fibres (RCF) are man-made mineral fibres used in high performance thermal insulation applications. Analogous to asbestos fibres, RCF are respirable, show a pleural drift and can persist in human lung tissue for more than 20 years after exposure. Pleural changes such as localised or diffuse pleural thickening as well as pleural calcification were reported. RESULT: A 45 years old man worked in high performance thermal insulation applications using refractory ceramic fibres (RCF) for almost 20 years. During a occupational medical prophylaxis to ensure early diagnosis of disorders caused by inhalation of aluminium silicate fibres with X-ray including high-resolution computed tomography (HRCT), bilateral pleural thickening was shown and a pleural calcification next to a rounded atelectasis was detected. Asbestos exposure could be excluded. In pulmonary function test a restrictive lung pattern could be revealed. In work samples scanning electron microscopy (SEM) including energy dispersive X-ray analysis (EDX) classified used fibres as aluminium silicate fibres. X-ray powder diffraction (XRD) and transmission electron microscopy (TEM) showed crystalline as well as amorphous fibres. CONCLUSIONS: A comprehensive lung function analysis and in case of restrictive lung disorders additional CT scans are needed in RCF exposed workers in accordance to the guidelines for medical occupational examinations comparable to asbestos exposed workers.

Asunto(s)

Exposición Profesional , Atelectasia Pulmonar , Cerámica/toxicidad , Humanos , Microscopía Electrónica de Rastreo , Persona de Mediana Edad , Fibras Minerales/toxicidad , Exposición Profesional/efectos adversos , Exposición Profesional/análisis , Atelectasia Pulmonar/inducido químicamente , Atelectasia Pulmonar/diagnóstico por imagen , Pruebas de Función Respiratoria

RESUMEN

BACKGROUND: Thoracic radiography in awake cats is a common procedure for the evaluation of pulmonary metastasis in feline mammary gland carcinoma (MGC). However, due to poor sensitivity, computed tomography (CT) is progressively taking its place. To perform CT in animals, general anesthesia is normally preferred but can cause lung atelectasis, affecting lung interpretation. Besides, MGC is often found in senile cats that are concurrently affected with other diseases, increasing anesthetic risk. Therefore, this study was aimed at comparing the effect of anesthesia on lung atelectasis observed through CT in clinically healthy cats and comparing the feasibility of non-anesthetic CT with non-anesthetic radiography in the detection of lung lesions in feline MGC. Thoracic CTs from anesthetized, clinically healthy cats and non-anesthetized either clinically healthy cats or MGC-affected cats were reviewed. In clinically healthy cats, motion artifacts and characteristics of lung atelectasis were observed and compared. In MGC-affected cats, motion artifacts were observed and compared to clinically healthy cats, and the number of MGC-affected cats, the number and characteristics of lung lesions were compared between non-anesthetic thoracic CT and radiography. RESULTS: Anesthesia significantly increased lung CT attenuation (P = 0.0047) and was significantly correlated with lung atelectasis (OR = 15; CI 2.02-111.18; P = 0.0081), particularly of the cranial lung lobe. Nonetheless, significantly higher motion artifacts in the caudal thoracic area were found in non-anesthetized healthy cats (P = 0.0146), but comparable low motion artifacts were observed in anesthetized healthy and MGC-affected cats. Non-anesthetic CT revealed higher numbers of MGC-affected cats and pulmonary nodules with a significantly lower nodular diameter (P = 0.0041) than those observed on radiographs. The smallest nodular diameters detected on radiographs and CT were 2.5 and 1.0 mm, respectively. Furthermore, CT showed additional information such as intra-thoracic lymphadenopathy, that could not be seen on radiographs. CONCLUSIONS: Despite the motion artifacts, CT without anesthesia is a sensitive technique as it provides better lung inflation. Furthermore, compared to non-anesthetic radiography, non-anesthetic CT provided more information such as higher number of pulmonary nodules of a smaller size, including more distinct intra-thoracic lesions, such as lymphadenopathy, in MGC-affected cats.

Asunto(s)

Enfermedades de los Gatos/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Neoplasias Mamarias Animales/diagnóstico por imagen , Tomografía Computarizada por Rayos X/veterinaria , Anestesia/efectos adversos , Anestesia/veterinaria , Animales , Artefactos , Gatos , Femenino , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Atelectasia Pulmonar/inducido químicamente , Radiografía Torácica/veterinaria

RESUMEN

OBJECTIVE: Chronic opioid use (COU) remains on the rise globally, acting as a marker for patient morbidity and a risk factor for adverse health outcomes. Opioid use is a risk factor for respiratory depression, which may lead to dysfunctional breathing, a known cause of atelectasis. The objective of this study was to determine whether COU is associated with increased rates of postoperative atelectasis among patients undergoing lumbar fusion. MATERIALS & METHODS: Three State Inpatient Databases were used to identify patients who underwent an elective lumbar fusion through an anterior, posterior or circumferential approach in Florida, Kentucky and New York between 2013-2015. Patients with COU and those with postoperative atelectasis were identified using ICD diagnosis codes. Three operative groups were created and subsequently matched using propensity scores in order to provide comparable cohorts for analysis. Three-to-one propensity score matching was conducted using the variables of age, sex, race, number of chronic diagnoses and geographic state of admission. Multivariable logistic regressions were used to examine the relationship between COU and postoperative atelectasis. RESULTS: A total of 3618 lumbar fusions were identified. Atelectasis was noted in 1.33 % of NCOU patients and 2.32 % of COU patients. On multivariable analysis, while controlling for the Elixhauser Mortality Index and patient insurance status, COU was significantly associated with atelectasis in posterior lumbar fusion (OR = 2.27; CI: 1.09-4.72; p = 0.028) and circumferential lumbar fusion (OR = 4.68; CI: 1.52-14.45; p = 0.007). The Elixhauser Mortality Index was also significantly associated with atelectasis in posterior lumbar fusion (OR = 1.08; CI: 1.04-1.11; p < 0.001) and circumferential lumbar fusion (OR = 1.09; CI: 1.03-1.16; p = 0.002). CONCLUSION: Higher rates of postoperative atelectasis were found among patients with COU following posterior and circumferential lumbar fusions. The Elixhauser Mortality Index was also independently associated with atelectasis. Knowledge of these risks may allow for earlier identification and intervention in patients who are at risk.

Asunto(s)

Analgésicos Opioides/efectos adversos , Vértebras Lumbares/cirugía , Complicaciones Posoperatorias/epidemiología , Atelectasia Pulmonar/epidemiología , Fusión Vertebral/efectos adversos , Adulto , Anciano , Analgésicos Opioides/administración & dosificación , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/diagnóstico , Prevalencia , Puntaje de Propensión , Atelectasia Pulmonar/inducido químicamente , Atelectasia Pulmonar/diagnóstico , Fusión Vertebral/tendencias

RESUMEN

BACKGROUND: Hyperinflation has been associated with negative cardiocirculatory consequences in patients with chronic obstructive pulmonary disease (COPD). These abnormalities are likely to worsen when the demands for O2 increase, e.g., under the stress of exercise. Thus, pharmacologically-induced lung deflation may improve cardiopulmonary interactions and exertional cardiac output leading to higher limb muscle blood flow and oxygenation in hyperinflated patients with COPD. METHODS: 20 patients (residual volume = 201.6 ±â€¯63.6% predicted) performed endurance cardiopulmonary exercise tests (75% peak) 1 h after placebo or tiotropium/olodaterol 5/5 µg via the Respimat® inhaler (Boehringer Ingelheim, Ingelheim am Rhein, Germany). Cardiac output was assessed by signal-morphology impedance cardiography. Near-infrared spectroscopy determined quadriceps blood flow (indocyanine green dye) and intra-muscular oxygenation. RESULTS: Tiotropium/olodaterol was associated with marked lung deflation (p < 0.01): residual volume decreased by at least 0.4 L in 14/20 patients (70%). The downward shift in the resting static lung volumes was associated with less exertional inspiratory constraints and dyspnoea thereby increasing exercise endurance by ~50%. Contrary to our premises, however, neither central and peripheral hemodynamics nor muscle oxygenation improved after active intervention compared to placebo. These results were consistent with those found in a subgroup of patients showing the largest decrements in residual volume (p < 0.05). CONCLUSIONS: The beneficial effects of tiotropium/olodaterol on resting and operating lung volumes are not translated into enhanced cardiocirculatory responses to exertion in hyperinflated patients with COPD. Improvement in exercise tolerance after dual bronchodilation is unlikely to be mechanistically linked to higher muscle blood flow and/or O2 delivery.

Asunto(s)

Benzoxazinas/efectos adversos , Broncodilatadores/efectos adversos , Gasto Cardíaco/efectos de los fármacos , Atelectasia Pulmonar/inducido químicamente , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Bromuro de Tiotropio/efectos adversos , Anciano , Anciano de 80 o más Años , Benzoxazinas/administración & dosificación , Benzoxazinas/uso terapéutico , Broncodilatadores/administración & dosificación , Broncodilatadores/uso terapéutico , Estudios de Casos y Controles , Estudios Cruzados , Estudios Transversales , Combinación de Medicamentos , Disnea/fisiopatología , Prueba de Esfuerzo/métodos , Tolerancia al Ejercicio/efectos de los fármacos , Femenino , Hemodinámica/fisiología , Humanos , Masculino , Persona de Mediana Edad , Nebulizadores y Vaporizadores , Oxígeno/metabolismo , Esfuerzo Físico/efectos de los fármacos , Placebos/administración & dosificación , Músculo Cuádriceps/irrigación sanguínea , Músculo Cuádriceps/diagnóstico por imagen , Músculo Cuádriceps/metabolismo , Flujo Sanguíneo Regional/efectos de los fármacos , Volumen Residual/efectos de los fármacos , Espectroscopía Infrarroja Corta/métodos , Bromuro de Tiotropio/administración & dosificación , Bromuro de Tiotropio/uso terapéutico

RESUMEN

OBJECTIVES: Lung ultrasound can reliably diagnose pulmonary atelectasis. The object of this study is to determine the most efficient region to assess changes in atelectasis in children with congenital heart disease under general anesthesia. DESIGN: Randomized controlled trial. SETTING: Operating room at university-affiliated children's hospital. PATIENTS: Children between 3 months and 3 years old, scheduled for elective congenital heart disease surgery under general anesthesia. INTERVENTIONS: Forty children with congenital heart disease were randomly allocated to either a 5 cm H2O positive end-expiratory pressure group or a standard therapy control group. MEASUREMENTS AND MAIN RESULTS: Preoperative lung ultrasound was performed twice in each patient-after 1 and 15 minutes of mechanical ventilation. Atelectatic areas and B-lines were compared between two examinations. Different ultrasound regions were evaluated using Bland-Altman plots. The occurrence rate of atelectasis was much higher in inferoposterior lung regions (Scans 4-6) than in anterior and lateral regions (Scans 1-3). The median (interquartile range) lung ultrasound scores were lower in the positive end-expiratory pressure group than in the control group after treatment: 8 (3.3-9.8) versus 13 (8.3-17.5; p < 0.001). The atelectatic area was significantly decreased after treatment in the positive end-expiratory pressure group: 128 mm (34.5.5-213.3 mm) versus 49.5 mm (5.3-75.5 mm; p < 0.001). Bland-Altman plots revealed concordance between measurements in Scans 1-6 and those in Scans 4-6. In the posterior axillary line regions, changes in atelectatic area were significantly larger in the positive end-expiratory pressure group than in the control group (p = 0.03, 0.007, and 0.018). CONCLUSIONS: Lung ultrasound in inferoposterior lung regions may be more likely to reflect changes in atelectasis and save examination time; 5 cm H2O positive end-expiratory pressure may be useful in lung reaeration and can reduce, but not eliminate, atelectasis in children with congenital heart disease.

Asunto(s)

Pulmón/diagnóstico por imagen , Respiración con Presión Positiva/métodos , Atelectasia Pulmonar/terapia , Anestesia General/efectos adversos , Preescolar , Femenino , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Pulmón/patología , Masculino , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/terapia , Atelectasia Pulmonar/inducido químicamente , Ultrasonografía

RESUMEN

A 55 year old female with rheumatoid arthritis who was repeatedly admitted to internal medicine for fever, shortness of breath and pleuritic chest pain. Laboratory work up showed normal WBC but elevated CRP and sedimentatation rate. Cultures were negative. Imaging studies revealed elevated diaphragms, bilateral atelectasis and pleural fluid but normal lung parenchyma. Lung function testing showed restriction. Anti-dsDNA and anti-Ro/SSA were elevated. A clinical diagnosis of anti-TNF-induced lupus secondary to infliximab and shrinking lung syndrome was made. The patient showed improvement on steroids but subsequent worsening when tapered. Rituximab was then initiated with good results. Key words: rheumatoid arthritis, infliximab, restrictive lung disease, shrinking lung syndrome, anti-TNF induced lupus. Correspondence: Thorunn Halldora Thordardottir, thorhtho@landspitali.is.

Asunto(s)

Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Infliximab/efectos adversos , Enfermedades Pulmonares/inducido químicamente , Lupus Eritematoso Sistémico/inducido químicamente , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/inmunología , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/inmunología , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/inmunología , Persona de Mediana Edad , Atelectasia Pulmonar/inducido químicamente , Pruebas de Función Respiratoria , Rituximab/administración & dosificación , Esteroides/administración & dosificación , Esteroides/efectos adversos , Síndrome , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/inmunología

RESUMEN

Perfluoroalkyl substances (PFASs) are persistent environmental contaminants. Perfluorooctane sulfonate (PFOS) and Perfluorooctanoic acid (PFOA) are representatives of PFASs. Recently, the U.S. Environmental Protection Agency (US EPA) set the health advisory level as 70 parts per trillion for lifetime exposure to PFOS and PFOA from drinking water, based on the EPA's 2016 Health Effects Support Documents. Then, a monograph on PFOA was made available online by the International Agency for Research on Cancer, where the agency classified PFOA as "possibly carcinogenic to humans" (Group 2B). The distinction between PFOS and PFOA, however, may not be easily understood from the above documents. This paper discussed differential toxicity between PFOS and PFOA focusing on neurotoxicity, developmental toxicity and carcinogenicity, mainly based on these documents. The conclusions are as follows: Further mechanistic studies may be necessary for ultrasonic-induced PFOS-specific neurotoxicity. To support the hypothesis for PFOS-specific neonatal death that PFOS interacts directly with components of natural lung surfactant, in vivo studies to relate the physicochemical effects to lung collapse may be required. PFOA-induced DNA damage secondary to oxidative stress may develop to mutagenicity under the condition where PFOA-induced apoptosis is not sufficient to remove the damaged cells. A study to find whether PFOA induces apoptosis in normal human cells may contribute to assessment of human carcinogenicity. Studies for new targets such as hepatocyte nuclear factor 4α (HNF4α) may help clarify the underlying mechanism for PFOA-induced carcinogenicity.

Asunto(s)

Ácidos Alcanesulfónicos/toxicidad , Caprilatos/toxicidad , Fluorocarburos/toxicidad , Animales , Trastorno por Déficit de Atención con Hiperactividad/inducido químicamente , Daño del ADN/efectos de los fármacos , Humanos , Neoplasias/inducido químicamente , Sistema Nervioso/efectos de los fármacos , Estrés Oxidativo , Muerte Perinatal/etiología , Atelectasia Pulmonar/inducido químicamente , Ratas Sprague-Dawley

Asunto(s)

Anestesia General/efectos adversos , Pulmón/diagnóstico por imagen , Atelectasia Pulmonar/inducido químicamente , Atelectasia Pulmonar/diagnóstico por imagen , Femenino , Humanos , Masculino , Ultrasonografía

Asunto(s)

Anestesia General/efectos adversos , Pulmón/diagnóstico por imagen , Atelectasia Pulmonar/inducido químicamente , Atelectasia Pulmonar/diagnóstico por imagen , Femenino , Humanos , Masculino , Ultrasonografía

RESUMEN

PURPOSE: To analyze microscopically the effects of different concentrations of oxygen in the lungs of rats. METHODS: There were 20 rats distributed in three experimental groups (concentration of oxygen to 40%, 70% and 100%) and a control group. The animals were exposed to the oxygen in a chamber of acrylic during three days and after exposition, the animals were submitted to median thoracotomia to remove the lungs. The lung tissue of all of the animals was analyzed as regards presence of acute and chronic inflammation, capillary congestion, alveolar walls thick, interstitial and alveolar edema, alveolar hemorrhage, denudation capillary and alveolar endothelium areas and atelectasis. RESULTS: The analysis histopathologic revealed significant statistics difference for acute and chronic inflammation, capillary congestion, alveolar walls thick, interstitial and alveolar edema, alveolar hemorrhage, denudation capillary and alveolar epithelium areas. CONCLUSIONS: Exposition to the oxygen during 72 hours in the concentration of 40% does not produce significant histopathologic alterations in the lung tissue; in the concentration of 70%, can promotes the alveolar walls thick and capillary congestion and in the concentration of 100% can cause death and originate diffuse pulmonary lesion.

Asunto(s)

Pulmón/patología , Oxígeno/efectos adversos , Alveolos Pulmonares/patología , Animales , Femenino , Hiperemia/inducido químicamente , Modelos Animales , Oxígeno/toxicidad , Neumonía/inducido químicamente , Alveolos Pulmonares/lesiones , Atelectasia Pulmonar/inducido químicamente , Distribución Aleatoria , Ratas Wistar , Factores de Tiempo

RESUMEN

PURPOSE: To analyze microscopically the effects of different concentrations of oxygen in the lungs of rats. METHODS: There were 20 rats distributed in three experimental groups (concentration of oxygen to 40%, 70% and 100%) and a control group. The animals were exposed to the oxygen in a chamber of acrylic during three days and after exposition, the animals were submitted to median thoracotomia to remove the lungs. The lung tissue of all of the animals was analyzed as regards presence of acute and chronic inflammation, capillary congestion, alveolar walls thick, interstitial and alveolar edema, alveolar hemorrhage, denudation capillary and alveolar endothelium areas and atelectasis. RESULTS: The analysis histopathologic revealed significant statistics difference for acute and chronic inflammation, capillary congestion, alveolar walls thick, interstitial and alveolar edema, alveolar hemorrhage, denudation capillary and alveolar epithelium areas. CONCLUSIONS: Exposition to the oxygen during 72 hours in the concentration of 40% does not produce significant histopathologic alterations in the lung tissue; in the concentration of 70%, can promotes the alveolar walls thick and capillary congestion and in the concentration of 100% can cause death and originate diffuse pulmonary lesion. .

Asunto(s)

Animales , Femenino , Oxígeno/efectos adversos , Alveolos Pulmonares/patología , Pulmón/patología , Oxígeno/toxicidad , Neumonía/inducido químicamente , Alveolos Pulmonares/lesiones , Atelectasia Pulmonar/inducido químicamente , Factores de Tiempo , Distribución Aleatoria , Ratas Wistar , Modelos Animales , Hiperemia/inducido químicamente

RESUMEN

BACKGROUND: We tested the hypothesis that neostigmine reversal of neuromuscular blockade reduced the incidence of signs and symptoms of postoperative respiratory failure. METHODS: We enrolled 3,000 patients in this prospective, observer-blinded, observational study. We documented the intraoperative use of neuromuscular blocking agents and neostigmine. At postanesthesia care unit admission, we measured train-of-four ratio and documented the ratio of peripheral oxygen saturation to fraction of inspired oxygen (S/F). The primary outcome was oxygenation at postanesthesia care unit admission (S/F). Secondary outcomes included the incidence of postoperative atelectasis and postoperative hospital length of stay. Post hoc, we defined high-dose neostigmine as more than 60 µg/kg and unwarranted use of neostigmine as neostigmine administration in the absence of appropriate neuromuscular transmission monitoring. RESULTS: Neostigmine reversal did not improve S/F at postanesthesia care unit admission (164 [95% CI, 162 to 164] vs. 164 [161 to 164]) and was associated with an increased incidence of atelectasis (8.8% vs. 4.5%; odds ratio, 1.67 [1.07 to 2.59]). High-dose neostigmine was associated with longer time to postanesthesia care unit discharge readiness (176 min [165 to 188] vs. 157 min [153 to 160]) and longer postoperative hospital length of stay (2.9 days [2.7 to 3.2] vs. 2.8 days [2.8 to 2.9]). Unwarranted use of neostigmine (n = 492) was an independent predictor of pulmonary edema (odds ratio, 1.91 [1.21 to 3.00]) and reintubation (odds ratio, 3.68 [1.10 to 12.4]). CONCLUSIONS: Neostigmine reversal did not affect oxygenation but was associated with increased atelectasis. High-dose neostigmine or unwarranted use of neostigmine may translate to increased postoperative respiratory morbidity.

Asunto(s)

Neostigmina/efectos adversos , Neostigmina/uso terapéutico , Fármacos Neuromusculares no Despolarizantes/antagonistas & inhibidores , Parasimpaticomiméticos/efectos adversos , Parasimpaticomiméticos/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/fisiopatología , Insuficiencia Respiratoria/prevención & control , Insuficiencia Respiratoria/fisiopatología , Adulto , Anciano , Extubación Traqueal , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neostigmina/administración & dosificación , Parasimpaticomiméticos/administración & dosificación , Atelectasia Pulmonar/inducido químicamente , Resultado del Tratamiento

RESUMEN

BACKGROUND: The aim of this study was to test the accuracy of lung sonography (LUS) to diagnose anesthesia-induced atelectasis in children undergoing magnetic resonance imaging (MRI). METHODS: Fifteen children with American Society of Anesthesiology's physical status classification I and aged 1 to 7 yr old were studied. Sevoflurane anesthesia was performed with the patients breathing spontaneously during the study period. After taking the reference lung MRI images, LUS was carried out using a linear probe of 6 to 12 MHz. Atelectasis was documented in MRI and LUS segmenting the chest into 12 similar anatomical regions. Images were analyzed by four blinded radiologists, two for LUS and two for MRI. The level of agreement for the diagnosis of atelectasis among observers was tested using the κ reliability index. RESULTS: Fourteen patients developed atelectasis mainly in the most dependent parts of the lungs. LUS showed 88% of sensitivity (95% CI, 74 to 96%), 89% of specificity (95% CI, 83 to 94%), and 88% of accuracy (95% CI, 83 to 92%) for the diagnosis of atelectasis taking MRI as reference. The agreement between the two radiologists for diagnosing atelectasis by MRI was very good (κ, 0.87; 95% CI, 0.72 to 1; P < 0.0001) as was the agreement between the two radiologists for detecting atelectasis by LUS (κ, 0.90; 95% CI, 0.75 to 1; P < 0.0001). MRI and LUS also showed good agreement when data from the four radiologists were pooled and examined together (κ, 0.75; 95% CI, 0.69 to 0.81; P < 0.0001). CONCLUSION: LUS is an accurate, safe, and simple bedside method for diagnosing anesthesia-induced atelectasis in children.

Asunto(s)

Anestesia General/efectos adversos , Pulmón/diagnóstico por imagen , Atelectasia Pulmonar/inducido químicamente , Atelectasia Pulmonar/diagnóstico por imagen , Niño , Preescolar , Ecocardiografía/normas , Femenino , Humanos , Lactante , Masculino , Proyectos Piloto , Reproducibilidad de los Resultados

RESUMEN

General anesthesia is frequently associated to transient hypoxemia and lung atelectasis. Although volatile anesthetics are safe and widely used, their potential role on anesthesia-induced pulmonary impairment has not been fully explored. In this study, we investigated the effect of volatile anesthetic sevoflurane on pulmonary surfactant composition and structure that could contribute to atelectasis. After 30 min of sevoflurane anesthesia, Sprague-Dawley rats showed increased levels of lyso-phosphatidylcholine and decreased levels of phosphatidylcholine associated with significant impairment in lung mechanics and alveolar collapse, but showed no deterioration of alveolar fluid reabsorption when compared to control group of rats anesthetized with pentobarbital. Exposure to sevoflurane altered the thermotropic profile of surfactant model membranes, as detected by fluorescence anisotropy. In this sense, sevoflurane-promoted fluidification of condensed phases could potentially impair the ability of surfactant films to sustain the lowest surface tensions. In conclusion, the observed changes in surfactant composition and viscosity properties suggest a direct effect of sevoflurane on surfactant function, a factor potentially involved in anesthetic-induced alterations in lung mechanics.

Asunto(s)

Anestésicos por Inhalación/toxicidad , Éteres Metílicos/toxicidad , Alveolos Pulmonares/efectos de los fármacos , Surfactantes Pulmonares/metabolismo , Animales , Polarización de Fluorescencia , Lisofosfatidilcolinas/metabolismo , Masculino , Fosfatidilcolinas/metabolismo , Alveolos Pulmonares/patología , Atelectasia Pulmonar/inducido químicamente , Ratas , Ratas Sprague-Dawley , Sevoflurano , Tensión Superficial/efectos de los fármacos , Viscosidad/efectos de los fármacos

RESUMEN

General anesthesia is known to cause pulmonary atelectasis; in turn, atelectasis increases shunt, decreases compliance, and may lead to perioperative hypoxemia. One mechanism for the formation of atelectasis intraoperatively is ventilation with 100% oxygen. The goal of this review is to determine if research suggests that intraoperative ventilation with 100% oxygen leads to clinically significant pulmonary side effects. An initial literature search included electronic databases (Cumulative Index to Nursing & Allied Health Literature [CINAHL], PubMed, MEDLINE, Embase, and The GeneraCochrane Library) using the following search terms: oxygen (administration and dosage), atelectasis, pulmonary complications, and anesthesia. Results were limited to research studies, human subjects, and English-language publications between 1965 and 2011. From this body of research, it appears that absorption atelectasis does occur in healthy anesthetized adults breathing 100% oxygen. Data reviewed suggest that absorption atelectasis does not have significant clinical implications in healthy adults. However, further research is warranted in populations at increased risk of postoperative hypoxemia, including obese or elderly patients and those with preexisting cardiopulmonary disease.

Asunto(s)

Anestesia General/efectos adversos , Enfermeras Anestesistas , Terapia por Inhalación de Oxígeno/métodos , Atelectasia Pulmonar , Humanos , Incidencia , Terapia por Inhalación de Oxígeno/efectos adversos , Atelectasia Pulmonar/inducido químicamente , Atelectasia Pulmonar/epidemiología , Atelectasia Pulmonar/terapia

RESUMEN

This article challenges the use of hyperoxia in the perioperative period. It describes the biochemical and physiologic basis for both the direct and indirect adverse effects of oxygen. The reasons for using hyperoxia in the perioperative period are critically evaluated, and the evidence and guidelines for oxygen use in common acute medical conditions are reviewed.

Asunto(s)

Terapia por Inhalación de Oxígeno/efectos adversos , Oxígeno/efectos adversos , Atención Perioperativa , Antioxidantes/metabolismo , Humanos , Hiperoxia/complicaciones , Hiperoxia/etiología , Hiperoxia/fisiopatología , Hiperoxia/terapia , Ventilación Unipulmonar , Oxígeno/química , Atelectasia Pulmonar/inducido químicamente , Atelectasia Pulmonar/terapia , Especies Reactivas de Oxígeno

RESUMEN

Airway management is primarily designed to avoid hypoxia, yet hypoxia remains the main ultimate cause of anaesthetic-related death and morbidity. Understanding some of the physiology of hypoxia is therefore essential as part of a 'holistic' approach to airway management. Furthermore, it is strategically important that national specialist societies dedicated to airway management do not only focus upon the technical aspects of airway management, but also embrace some of the relevant scientific questions. There has been a great deal of research into causation of hypoxia and the body's natural protective mechanisms and responses to it. This enables us to think of ways in which we might manipulate the cellular and molecular responses to confer greater protection against hypoxia-induced tissue injury. This article reviews some of those aspects.

Asunto(s)

Manejo de la Vía Aérea/métodos , Hipoxia/terapia , Adaptación Fisiológica/fisiología , Analgésicos Opioides/efectos adversos , Periodo de Recuperación de la Anestesia , Anestesia por Inhalación , Anestésicos por Inhalación/farmacología , Humanos , Hipoxia/etiología , Hipoxia/fisiopatología , Mitocondrias/metabolismo , Mitocondrias/fisiología , Atelectasia Pulmonar/inducido químicamente , Atelectasia Pulmonar/fisiopatología , Respiración Artificial , Mecánica Respiratoria/fisiología

RESUMEN

BACKGROUND: atelectasis is a common consequence of pre-oxygenation with 100% oxygen during induction of anaesthesia. Lowering the oxygen level during pre-oxygenation reduces atelectasis. Whether this effect is maintained during anaesthesia is unknown. METHODS: during and after pre-oxygenation and induction of anaesthesia with 60%, 80% or 100% oxygen concentration, followed by anaesthesia with mechanical ventilation with 40% oxygen in nitrogen and positive end-expiratory pressure of 3 cmH(2) O, we used repeated computed tomography (CT) to investigate the early (0-14 min) vs. the later time course (14-45 min) of atelectasis formation. RESULTS: in the early time course, atelectasis was studied awake, 4, 7 and 14 min after start of pre-oxygenation with 60%, 80% or 100% oxygen concentration. The differences in the area of atelectasis formation between awake and 7 min and between 7 and 14 min were significant, irrespective of oxygen concentration (P<0.05). During the late time course, studied after pre-oxygenation with 80% oxygen, the differences in the area of atelectasis formation between awake and 14 min, between 14 and 21 min, between 21 and 28 min and finally between 21 and 45 min were all significant (P<0.05). CONCLUSION: formation of atelectasis after pre-oxygenation and induction of anaesthesia is oxygen and time dependent. The benefit of using 80% oxygen during induction of anaesthesia in order to reduce atelectasis diminished gradually with time.

Asunto(s)

Anestesia/efectos adversos , Complicaciones Intraoperatorias/inducido químicamente , Complicaciones Intraoperatorias/metabolismo , Consumo de Oxígeno/fisiología , Oxígeno/administración & dosificación , Oxígeno/efectos adversos , Atelectasia Pulmonar/inducido químicamente , Adulto , Femenino , Humanos , Histerectomía , Pulmón/diagnóstico por imagen , Persona de Mediana Edad , Modelos Estadísticos , Respiración con Presión Positiva , Atelectasia Pulmonar/diagnóstico por imagen , Respiración Artificial , Tomografía Computarizada por Rayos X

RESUMEN

Rounded atelectasis is an unusual form of peripheral atelectasis that develops as a consequence of pleural disease. It is usually thought to be a benign process after malignancy and infection have been excluded. Pergolide is an ergot-derived dopamine agonist that has been associated with pleuropulmonary fibrosis and fibrotic cardiac valve disease. Pergolide-associated rounded atelectasis has occurred in patients with known asbestos exposure. We report a patient with no known asbestos exposure who developed rounded atelectasis and subsequent symptomatic diffuse restrictive pleural disease. Physicians should consider drugs early on in their work-up of rounded atelectasis as discontinuation of the agent may reverse the process.

Asunto(s)

Antiparkinsonianos/efectos adversos , Pergolida/efectos adversos , Enfermedades Pleurales/inducido químicamente , Atelectasia Pulmonar/inducido químicamente , Anciano , Antiparkinsonianos/uso terapéutico , Humanos , Masculino , Enfermedad de Parkinson/tratamiento farmacológico , Pergolida/uso terapéutico , Enfermedades Pleurales/diagnóstico , Atelectasia Pulmonar/diagnóstico

Asunto(s)

Anticuerpos Monoclonales/efectos adversos , Antineoplásicos/efectos adversos , Neoplasias de la Mama/tratamiento farmacológico , Carcinoma Intraductal no Infiltrante/tratamiento farmacológico , Oligohidramnios/inducido químicamente , Complicaciones Neoplásicas del Embarazo/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados , Cesárea , Terapia Combinada , Resultado Fatal , Femenino , Humanos , Pulmón/anomalías , Embarazo , Atelectasia Pulmonar/inducido químicamente , Trastuzumab