Onset Of Spontaneous Respiration Research Articles

Changes in Cord Arterial Blood Gas Parameters by the Onset of Spontaneous Respiration during Delayed Cord Clamping

Changes in Cord Arterial Blood Gas Parameters by the Onset of Spontaneous Respiration during Delayed Cord Clamping

Neonatal outcome following cord clamping after onset of spontaneous respiration.

Evolving data indicate that cord clamping (CC) beyond 30 to 60 seconds after birth is of benefit for all infants. Recent experimental data demonstrated that ventilation before CC improved cardiovascular stability by increasing pulmonary blood flow. The objective was to describe the relationship between time to CC, onset of spontaneous respirations (SR), and 24-hour neonatal outcome. In a rural Tanzanian hospital, trained research assistants, working in shifts, have observed every delivery (November 2009-February 2013) and recorded data including time interval from birth to SR and CC, fetal heart rate, perinatal characteristics and outcome (normal, death, admission). Of 15,563 infants born, 12,780 (84.3%) initiated SR at 10.8 ± 16.7 seconds, and CC occurred at 63 ± 45 seconds after birth. Outcomes included 12,730 (99.7%) normal, 31 deaths, and 19 admitted; 11,967 were of birth weight (BW) ≥2500 g and 813 <2500 g. By logistic modeling, the risk of death/admission was consistently higher if CC occurred before SR. Infants of BW <2500 g were more likely to die or be admitted. The risk of death/admission decreased by 20% for every 10-second delay in CC after SR; this risk declined at the same rate in both BW groups. Healthy self-breathing neonates are more likely to die or be admitted if CC occurs before or immediately after onset of SR. These clinical observations support the experimental findings of a smoother cardiovascular transition when CC is performed after initiation of ventilation.

Neonatal Outcome Following Cord Clamping After Onset of Spontaneous Respiration

Neonatal Outcome Following Cord Clamping After Onset of Spontaneous Respiration

Postoperative Coma in a Child with Carnitine Palmitoyltransferase I Deficiency

Postoperative Coma in a Child with Carnitine Palmitoyltransferase I Deficiency

Postoperative Nachbeatmung in der „Eisernen Lunge”

Postoperative artificial ventilation by using an endotracheal tube may cause a pulmonary infection. A possibly necessary permanent sedation and relaxation may result in an additional danger for the patient. The principle of the "iron lung" represents an alternative to endotracheal artificial respiration, which applies especially to endangered patients who are under postoperative artificial respiration. After an abdominal operation five patients have been extubated and artificially respirated by using the "iron lung" principle while not being able to breath by themselves. The degree of the sedation was monitored both intraoperatively and postoperatively using an automatic EEG classification. The performance spectrum of the respiratory curve enabled very early detection of the onset of spontaneous respiration.

Determinants of the first inspiratory volume and functional residual capacity at birth.

We have investigated the pattern of pressure and volume changes that occur in vaginally delivered, full-term infants during the onset of spontaneous respiration. Within a few seconds of delivery of the head, simultaneous measurements were made of stomach and esophageal pressure changes together with volume changes determined at the mouth. Values obtained for volume were very similar, but pressure changes were of a greater magnitude than previously reported. A significant correlation has been shown between first inspiratory volume and functional residual capacity (FRC) at the end of the first breath (p less than 0.004). No significant relationship was found between first inspiratory pressure and FRC. However, using a calculated index of inspiratory pressure and time ("inspiratory effort"), a significant relationship of this to FRC was observed (p less than 0.02).

The concentration of bupivacaine in fetal organs during obstetrical epidural analgesia.

The concentration of bupivacaine in organs of non-viable human fetuses after obstetrical epidural analgesia in customary doses was investigated. The concentrations were determined with a gas chromatograph. The material consisted of a fetus who died following termination in the 24th week of pregnancy three minutes after birth without spontaneous respiration. The other fetus was born maturely in the 40th pregnancy week with anencephaly who lived 20 minutes following initial spontaneous respiration. Most noteworthy were the increased concentrations in the liver indicating the important metabolic function of the liver for the metabolism of bupivacaine in the fetus. Further a very high pulmonary concentration was found in the mature fetus. Even though blood gases analysis were not performed we conclude that: the lung is the best perfused organ after birth and onset of spontaneous respiration because of the closure of the ductus arteriosus; because of the increasing agonal respiratory acidosis, bupivacaine accumulates in the lung, the organ from which the acidosis originates. Also, the ionized form the bupivacaine is unable to leave the intracellular space. For the clinical use of epidural analgesia during delivery, these results constitute an important indication for avoiding fetal acidosis before and during the action of such analgesia. This mandates strict and continuous fetal monitoring. Our results in agreement with other authors show that during fetal acidosis and simultaneous administration of bupivacaine the fetal distress may be potentiated by an accelerated transfer of the anesthetic agent into the fetal placental space. Under normal conditions one may assume that this technique of analgesia has a positive effect on the fetus because of the improved placental perfusion.(ABSTRACT TRUNCATED AT 250 WORDS)

THE EFFECTS OF APNEA AND BRADYCARDIA ON CEREBRAL BLOOD FLOW VELOCITY (CBFV) IN THE PRETERM INFANT

Although apnea is a common neonatal problem, its impact on the cerebral circulation is unknown. CBFV was measured with the transcutaneous Doppler technique at the anterior fontanel. Determination of area under the velocity curve (A.U.V.C.) was utilized to quantitate CBFV. The objective of this study was to examine the effects of apnea on CBFV. Ten infants 15 sec. In each patient, the effects were similar. Initially, a decrease in diastolic flow velocity (DFV) occurred as the heart rate decreased. With marked brady-cardia (heart rate <80), a decrease in systolic flow velocity (SFV) developed and a further decrease in DFV was noted. SFV and DFV returned to baseline within sec. following the onset of spontaneous respiration, but with a delay in those requiring resuscitation. Simultaneous intra-arterial blood pressure (BP) recordings in 4 patients demonstrated similar changes in systolic and diastolic BP. Mean changes for 61 episodes is shown. The data show that apnea with bradycardia results in a progressive decrease in CBFV, most severe with heart rate <80. It seems possible that such repeated decreases in CBFV could cause or exacerbate cerebral hypoxic-ischemic injury.

Neonatal asphyxia. II. Neonatal mortality and long-term sequelae

Neonatal asphyxia, defined in this study as delay of greater than 1 minute in onset of spontaneous respiration at birth, occurred in 1% of 13,221 live-born infants of birth weight greater than 500 gm between 1970 and 1971. Seventy-five (56%) of 133 asphyxiated infants survived the neonatal period. Survival was directly related to gestational age. The 65 survivors of asphyxia available for study were seen at a mean age of 4.8 years to determine the incidence and extent of neurologic and developmental abnormalities. Twelve children (18.5%) had severe impairment: nine had both neurologic and intellectual handicaps, two had neurologic impairment alone, and one had intellectual impairment alone. The incidence and severity of impairment were not related to gestational age. Postasphyctic seizures were associated with poor outcome.

AN EVALUATION OF THE EFFECT OF METHOHEXITONE AND PROPANIDID ON BLOOD PRESSURE, PULSE RATE AND CARDIAC ARRHYTHMIA DURING ELECTROCONVULSIVE THERAPY

The effects of methohexitone and propanidid on the cardiovascular system of patients undergoing electroconvulsive therapy were evaluated on thirty-five patients. The anaesthetic and electroconvulsive therapy practice included intubation as a routine and pulmonary ventilation with 100 per cent oxygen between the administration of the shock and the onset of spontaneous respiration. The electrocardiogram was monitored continuously and the blood pressure and pulse rate were recorded at seven points in time during the procedure. In the evaluation only the first two treatment occasions were taken into consideration, methohexitone being used on one and propanidid on the other, the order for any given patient being determined at random. The effect of the order of the drugs was allowed for in the calculation of the results. Compared with propanidid, methohexitone was associated with higher systolic and diastolic blood pressures during the earlier stages and with lower pressures during the later stages. The higher blood pressures were in general associated with lower pulse rates and the lower pressures with slightly higher pulse rates. The return of spontaneous respiration was slower when propanidid rather than methohexitone was used. There was no reason to suspect a difference in the incidence of cardiac arrhythmia produced by the drugs.

METHODS OF ELEVATION OF PCO2 FOR RESTORATION OF SPONTANEOUS BREATHING AFTER ARTIFICIAL VENTILATION OF ANAESTHETIZED PATIENTS

SUMMARY Three methods for elevation of end-expiratory Pco 2 at the end of prolonged hyper-ventilation have been studied in 44 anaesthetized patients. The most rapid and repeatable method was the addition of 5 per cent carbon dioxide to the inspired gas for 5 minutes. This raised the end-expiratory Pco 2 from a mean value of 21.4 mm Hg to 41.8 mm Hg, and was associated with an onset of spontaneous respiration in a mean time of 2.2 min. Hypoventilation with a minute volume of 3 l./min for 5 minutes with a rebreathing circuit, without soda-lime, gave a slow rise of Pco 2 (mean rate 3 mm Hg/min) with a resumption of spontaneous respiration in a mean time of 4.5 min. Step reduction of minute volume from 10 to 5 l./min without rebreathing was a very slow and variable method of raising end-expiratory Pco 2 , with a mean time of 5.2 min before the restoration of spontaneous breathing.

METHODS OF ELEVATION OF Pco2 FOR RESTORATION OF SPONTANEOUS BREATHING AFTER ARTIFICIAL VENTILATION OF ANAESTHETIZED PATIENTS

SUMMARY Three methods for elevation of end-expiratory Pco 2 at the end of prolonged hyper-ventilation have been studied in 44 anaesthetized patients. The most rapid and repeatable method was the addition of 5 per cent carbon dioxide to the inspired gas for 5 minutes. This raised the end-expiratory Pco 2 from a mean value of 21.4 mm Hg to 41.8 mm Hg, and was associated with an onset of spontaneous respiration in a mean time of 2.2 min. Hypoventilation with a minute volume of 3 l./min for 5 minutes with a rebreathing circuit, without soda-lime, gave a slow rise of Pco 2 (mean rate 3 mm Hg/min) with a resumption of spontaneous respiration in a mean time of 4.5 min. Step reduction of minute volume from 10 to 5 l./min without rebreathing was a very slow and variable method of raising end-expiratory Pco 2 , with a mean time of 5.2 min before the restoration of spontaneous breathing.