Sequelae of Anaesthesia
T.M. Craft, P.M. Upton in Key Topics In Anaesthesia, 2021
Anaesthesia and surgery have many effects on the patient. Some are inevitable consequences, but many are avoidable with knowledge and appropriate care. The recovering patient is at risk of the same respiratory and cardiovascular complications as at induction, but these often occur when the level of monitoring has reduced and there is a less skilled person attending them. Some units have now introduced a trained anaesthetist dedicated to the recovery room — both to increase the level of care for patients and to encourage research and training. Atelectasis occurs on induction of anaesthesia with collapse of lung in dependent areas causing ventilation — perfusion mismatch. The incidence of corneal abrasion increases with operations lasting over 90 minutes, those on the head and neck and those where the patient is prone. Taping the eyes and the use of aqueous gel or soft contact lenses reduces the risk of corneal abrasion.
Thoracic trauma
Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven in Succeeding in Paediatric Surgery Examinations, 2017
Atelectasis often develops as a consequence of thoracic trauma or any significant trauma, often due to pain and splinting. Similarly, acute respiratory distress syndrome (ARDS) can be seen as a complication of thoracic trauma but also with severe multisystem injuries. The investigation of paediatric thoracic trauma starts with a chest X-ray in the trauma bay to exclude any injury that needs to be addressed emergently such as pneumothorax. A focused assessment sonography in trauma exam can also be performed in the trauma bay to identify a haemopericardium. The most frequent complications of paediatric chest trauma are atelectasis and pneumonia. Empyema is another complication that may occur with an undrained or inadequately drained haemothorax. Patients present with decreased oxygenation, increased respiratory rate, chest pain and fever. Most often, there will be complete opacification of the affected lung on chest X-ray. The treatment of ARDS relies on supportive measures such as high-frequency oscillatory ventilation.
Acceleration physiology
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol in Handbook of Aviation and Space Medicine, 2019
Gravity (G) is term used to describe magnitude of forces to which aircraft and spacecraft occupants are exposed. It is a measure of acceleration not force, despite its common language usage. G is produced when an aircraft turns, or a rocket increases speed. G exposure causes hydrostatic pressure gradient in blood vessels down body. This leads to a fall in head level blood pressure and blood pooling in legs. Acceleration atelectasis may cause symptoms and desaturation. G exposure has a profound effect on lung function; It rarely presents a problem in aviation due to relatively short G exposures involved, and healthy participants. Acceleration is a change in speed or direction. Acceleration causing change in direction is called centripetal acceleration. Term G is used to describe magnitude and direction as applied to human body. G causes closure of basal alveoli.
Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis
Published in Expert Review of Respiratory Medicine, 2015
Ruben D Restrepo, Jane Braverman
Innovations in surgery have significantly increased the number of procedures performed every year. While more individuals benefit from better surgical techniques and technology, a larger group of patients previously deemed ineligible for surgery now undergo high-complexity surgical procedures. Despite continuous improvements in the operating room and post-operative care, post-operative pulmonary complications (PPCs) continue to pose a serious threat to successful outcomes. PPCs are common, serious and costly. Growing awareness of the impact of PPCs has led to intensified efforts to understand the underlying causes. Current evidence demonstrates that a high proportion of PPCs are directly traceable to the pre-operative risk for and perioperative development of atelectasis. The substantial costs and losses associated with PPCs demand strategies to reduce their prevalence and impact. Effective interventions will almost certainly produce cost savings that significantly offset current economic and human resource expenditures. The purpose of this review is to describe the most common challenges encountered in the recognition, prevention and management of perioperative atelectasis. Expanding awareness and understanding of the role of atelectasis as a cause of PPCs can reduce their prevalence, impact important clinical outcomes and reduce the financial burden associated with treating these complications.
Nonhealing orbital floor fracture in a pediatric patient: A unique presentation of pseudo-silent sinus syndrome
Published in Orbit, 2018
Siwei Zhou, Katherine Duncan, S. Tonya Stefko
Silent sinus syndrome was first described as spontaneous enophthalmos and hypoglobus associated with subclinical maxillary sinusitis without prior trauma or surgery. This clinical entity has later been described after trauma in which damage to the ostiomeatal complex leads to atelectasis of the maxillary sinus. We report a case of a 14-year-old boy who presented 4 years after sustaining a non-operative orbital floor fracture with enophthalmos and transient diplopia. Computed tomography (CT) demonstrated enlargement in size of the original orbital floor fracture and bilateral maxillary sinus disease. Bilateral chronic sinusitis suggested an anatomical predisposition to sinusitis unrelated to the prior trauma. The authors propose that, in this case, negative pressure in the maxillary sinus and chronic inflammation led to bone resorption and failure of the orbital fracture to heal. This differs from prior reports of silent sinus syndrome in that there was complete resorption of bone of the orbital floor and no decrease in volume of the maxillary sinus given the open communication of the sinus and the orbit, making this a unique presentation of pseudo-silent sinus syndrome in a pediatric patient.
Hints for cyclical recruitment of atelectasis during ongoing mechanical ventilation in lavage and oleic acid lung injury detected by SpO
Published in Experimental Lung Research, 2014
Marc Bodenstein, Stefan Boehme, Hemei Wang, Bastian Duenges, Klaus Markstaller
Purpose of the Study: Detection of cyclical recruitment of atelectasis after induction of lavage (LAV) or oleic acid injury (OAI) in mechanically ventilated pigs. Primary hypothesis is that oxygen oscillations within the respiratory cycle can be detected by SpO2 recordings (direct hint). SpO2 oscillations reflect shunt oscillations that can only be explained by cyclical recruitment of atelectasis. Secondary hypothesis is that electrical impedance tomography (EIT) depicts specific regional changes of lung aeration and of pulmonary mechanical properties (indirect hint). Materials and Methods: Three groups (each n = 7) of mechanically ventilated pigs were investigated applying above mentioned methods before and repeatedly after induction of lung injury: (1) sham treated animals (SHAM), (2) LAV, and (3) OAI. Results: Early oxygen oscillations occurred in the LAV group (mean calculated amplitude: 73.8 mmHg reflecting shunt oscillation of 11.2% in mean). In the OAI group oxygen oscillations occurred hours after induction of lung injury (mean calculated amplitude: 57.1 mmHg reflecting shunt oscillations of 8.4% in mean). The SHAM group had no relevant oxygen oscillations (