Cases reported "Apnea"

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1/48. Haemoptysis after breath-hold diving.

    Pulmonary oedema has been described in swimmers and self-contained underwater breathing apparatus (Scuba) divers. This study reports three cases of haemoptysis secondary to alveolar haemorrhage in breath-hold divers. Contributory factors, such as haemodynamic modifications secondary to immersion, cold exposure, exercise and exposure to an increase in ambient pressure, could explain this type of accident. Furthermore, these divers had taken aspirin, which may have aggravated the bleeding.
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2/48. Factors determining the onset and course of hypoxemia during apnea: an investigation using physiological modelling.

    We used the Nottingham physiology Simulator to examine the onset and course of hypoxemia during apnea after pulmonary denitrogenation. The following factors, as possible determinants of the hypoxemia profile, were varied to examine their effect: functional residual capacity, oxygen consumption, respiratory quotient, hemoglobin concentration, ventilatory minute volume, duration of denitrogenation, pulmonary venous admixture, and state of the airway (closed versus open). Airway obstruction significantly reduced the time to 50% oxyhemoglobin saturation (8 vs 11 min). Provision of 100% oxygen rather than air to the open, apneic patient model greatly prolonged time to 50% oxyhemoglobin saturation (66 vs 11 min). Hemoglobin concentration, venous admixture, and respiratory quotient had small, insignificant effects on the time to desaturation. Reduced functional residual capacity, short duration of denitrogenation, hypoventilation, and increased oxygen consumption significantly shortened the time to 50% oxyhemoglobin saturation during apnea. IMPLICATIONS: Reduction in oxygen levels during cessation of breathing is dangerous and common in anesthetic practice. We used validated, mathematical, physiological models to reveal the impact of physiological factors on the deterioration of oxygen levels. This study could not be performed on patients and reveals important information.
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3/48. "apnea-volume" warning during normal ventilation of the lungs: an unusual leak in the Narkomed 4 anesthesia System.

    We report a case of an unusual breathing circuit leak in the Narkomed 4 anesthesia System due to a loose retaining ring at the junction of the expiratory valve assembly and the Spiromed Respiratory Volume Monitor. In the presence of the leak, the monitor panel displayed the messages "apnea volume" and "minute volume low," yet the low airway pressure alarm was not triggered and other parameters and clinical signs pointed to normal ventilation of the lungs. These conflicting data led to some delay in localizing the leak. After conclusion of the case, we found that occult loosening of this ring without causing leaks large enough to fail the FDA generic or manufacturer-recommended leak checks can occur. We recommend checking the tightness of this ring during routine leak checks and after rotating the expiratory valve assembly during re-positioning of the anesthetic system.
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4/48. Hypersomnia with periodic breathing (an acromegalic Pickwickian).

    The syndromes of Pickwickian, Ondine's curse, and primary alveolar hypoventilation are respiratory disorders manifesting increased sleepiness and irregular respiratory rhythms. These disorders are currently grouped as hypersomnia with periodic breathing (HPB). Polygraphic techniques have lead to a reasonable hypothesis as to the pathophysiology of the multiple variants of HPB. Discernible causes of HPB have been attributed to both central and peripheral factors. Peripheral factors encompass those conditions relating to upper airway obstruction. An acromegalic person suffering the HPB syndrome secondary to laryngeal stenosis is described.
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5/48. Failure of mouth-to-mouth resuscitation in cases of sudden infant death.

    We describe two cases of sudden infant death syndrome (SIDS) and one case of apparent life threatening apnoea where resuscitation was attempted by the mouth-to-mouth route. This was associated with evidence of gastric distension, including reflux of milk into the airway in the first two cases. In the second case the mother used mouth-to-mouth breathing after finding that she could not cover her baby's nose-and-open-mouth with her mouth. In the last case, the mother went on to try the mouth-to-nose route, with a good outcome. Systematic documentation of the route of resuscitation and its outcome in all cases of SIDS and near-miss SIDS may provide valuable insights into the optimal route for infant resuscitation.
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6/48. Unusual arachnoid cyst of the quadrigeminal cistern in an adult presenting with apneic spells and normal pressure hydrocephalus--case report.

    A 67-year-old woman was admitted to our clinic with symptoms of normal pressure hydrocephalus, lower cranial nerve pareses, and pyramidal and cerebellar signs associated with respiratory disturbances. Computed tomography (CT) and magnetic resonance imaging revealed a 4.7 x 5.4 cm quadrigeminal arachnoid cyst causing severe compression of the tectum and entire brain stem, aqueduct, and cerebellum, associated with moderate dilation of the third and lateral ventricles. Emergency surgery was undertaken due to sudden loss of consciousness and impaired breathing. The cyst was totally removed by midline suboccipital craniotomy in the prone position. Postoperatively, her symptoms improved except for the ataxia and impaired breathing. She was monitored cautiously for over 15 days. CT at discharge on the 18th postoperative day revealed decreased cyst size to 3.9 x 4.1 cm. Histological examination confirmed the diagnosis of the arachnoid cyst of the quadrigeminal cistern. The patient died of respiratory problems on the 5th day after discharge. Quadrigeminal arachnoid cysts may compress the brain stem and cause severe respiratory disturbances, which can be fatal due to apneic spells. patients should be monitored continuously in the preoperative and postoperative period until the restoration of autonomous ventilation is achieved.
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7/48. Unexpected prolonged neuromuscular block after mivacurium: a case report.

    OBJECTIVE: To present a case of unexpected prolonged apnoea following the administration of mivacurium, a short-acting muscle relaxant and to identify the factors for early diagnosis and management. CLINICAL PRESENTATION AND INTERVENTION: A 19-year-old physically fit lady without personal or family history suggestive of anaesthetic problems had an excision of fibro-adenoma from the breast. She did not recover as quickly as was expected from the anaesthetic, which included the administration of mivacurium. She had prolonged neuromuscular blockade. She was kept ventilated and sedated. Five hours after the last dose of mivacurium, she showed signs of spontaneous respiration and at 6 h she was extubated and fully recovered. It was shown later that the patient had a pseudocholinesterase deficiency. CONCLUSION: pseudocholinesterase deficiency is an uncommon occurrence but should be highly suspected in cases of prolonged paralysis following the administration of a short-acting muscle relaxant. The use of a nerve stimulator is recommended whenever muscle relaxants are used. Muscle relaxants should be used only when facilities for prolonged ventilation are available.
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keywords = respiration
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8/48. Central hypoventilation during quiet sleep in two infants.

    Expired ventilation (VE), tidal volume (VT), frequency (f), and alveolar PCO2 (PACO2) were examined in six normal infants at 41 to 52 weeks post-conceptional age and in two infants who were apneic at birth. Their response to breathing 5% carbon dioxide in air and to 100% oxygen in quiet sleep were compared to those in rapid eye movement (REM) sleep. VE in normal infants was 259 ml/kg/min in REM and 200.2 ml/kg/min in quiet sleep with the difference being due to decreased carbon dioxide production and to decreased dead space. VE increased 34.4 ml/kg/min/mm Hg of PCO2 elevation with 5% carbon dioxide breathing during REM and was not significantly different during quiet sleep. During oxygen breathing VE fell by 32.7% at 30 seconds before increasing again. In the affected infants, VE and PACO2 during REM at 1 and 4 months were normal. At 1 month, during quiet sleep, each infant became apneic and PACO2 rose 9 and 8 mm Hg/min respectively. At this time mechanical ventilation was begun. At 4 months, during quiet sleep, VE was 0.064 and 0.063 ml/kg/min at PACO2 of 66 mm Hg in each infant. The change was due entirely to a decrease in VT to 2.3 and 2.5 ml/kg. At this time 5% carbon dioxide breathing given during normal ventilation in REM produced an abrupt fall in VT to 2.0 and 2.2 ml/kg with no change in frequency. Oxygen breathing during REM at one month had no effect but at 4 months produced apnea requiring mechanical ventilation after one minute. The findings suggest that the ventilatory response to carbon dioxide is (1) important in initiation of extrauterine ventilation and (2) in sustaining ventilation particularly in quiet sleep. It is not necessary in sustaining ventilation awake or in REM sleep and it represents a balance between the stimulatory and depressant effects of carbon dioxide on the central nervous system.
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9/48. buspirone treatment for apneustic breathing in brain stem infarct.

    We report a case of brainstem infarction resulting in apneustic breathing, which was alleviated with buspirone. We discuss apneusis, review the literature, and speculate about the benefit of serotonin 1A receptor agonists in the treatment of apneusis and other respiratory disorders.
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10/48. Method for detection of respiratory cycle-related EEG changes in sleep-disordered breathing.

    STUDY OBJECTIVES: In sleep-disordered breathing (SDB), visual or computerized analysis of electroencephalogram (EEG) signals shows that disruption of sleep architecture occurs in association with apneas and hypopneas. We developed a new signal analysis algorithm to investigate whether brief changes in cortical activity can also occur with individual respiratory cycles. DESIGN: Retrospective. SETTING: University sleep laboratory. PARTICIPANTS: A 6 year-old boy with SDB. INTERVENTION: polysomnography before and after clinically indicated adenotonsillectomy. MEASUREMENTS: For the first 3 hours of nocturnal sleep, a computer algorithm divided nonapneic respiratory cycles into 4 segments and, for each, computed mean EEG powers within delta, theta, alpha, sigma, and beta frequency ranges. Differences between segment-specific EEG powers were tested by analysis of variance. Respiratory cycle-related EEG changes (RCREC) were quantified. RESULTS: Preoperative RCREC were statistically significant in delta (P < .0001), theta (P < .001), and sigma (P < .0001) but not alpha or beta (P > .01) ranges. One year after the operation, RCREC in all ranges showed statistical significance (P < .01), but delta, theta, and sigma RCREC had decreased, whereas alpha and beta RCREC had increased. Preoperative RCREC also were demonstrated in a sequence of 101 breaths that contained no apneas or hypopneas (P < .0001). Several tested variations in the signal-analysis approach, including analysis of the entire nocturnal polysomnogram, did not meaningfully improve the significance of RCREC. CONCLUSIONS: In this child with SDB, the EEG varied with respiratory cycles to a quantifiable extent that changed after adenotonsillectomy. We speculate that RCREC may reflect brief but extremely numerous microarousals.
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