The Experts below are selected from a list of 63 Experts worldwide ranked by ideXlab platform
Irene P. Osborn - One of the best experts on this subject based on the ideXlab platform.
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7207 Laryngeal mask airway: a novel means of maintaining a patent airway during endoscopy in patients receiving deep conscious sedation.
Gastrointestinal Endoscopy, 2000Co-Authors: Jonathan Cohen, Jonathan M. Reiber, Irene P. OsbornAbstract:Background: Aspiration, hypoxemia and hypoventilation are uncommon but serious complications during endoscopy. The risk of airway problems increases as higher doses of medications are used for sedation. The Laryngeal Mask Airway (LMA) is an FDA-approved device which is placed perorally and rests with its tip in the inferior recess of the hypopharynx. It is used as an alternative to endotracheal intubation. An ambu bag may be attached to the LMA for manual ventilation, if needed. Methods: We tested the feasibility of using the LMA to keep the airway open during concurrent passage of a therapeutic duodenoscope (diameter 13 mm). Patients were identified who were expected to require high doses of sedatives to undergo therapeutic ERCP. Individuals at high risk for aspiration were excluded. All patients received topical pharyngeal anesthesia with Cetacaine spray. After the administration of sedation, the LMA (diameter 15 mm) was placed by an anesthesiologist with the patient in the supine position. The patient was turned to the prone position and the duoedenoscope was passed by the staff gastroenterologist. Difficulty intubating the esophagus, friction encountered during the procedure as the endoscope was manipulated and episodes of hypoxia were recorded. Patients were interviewed after all procedures. Results: Ten patients underwent 12 ERCP's using propofol-based sedation regimens. An additional case was done using anesthetic gasses. The mean age was 51.4 years. The mean ASA class was 2.8. All procedures were successfully performed without oropharyngeal trauma. In each case, the endoscope was inserted around the LMA without dislodging the distensible rubber seal. Minimal friction between the LMA and the endoscope was appreciated by the endoscopist. In one patient, the seal loosened during the procedure leading to transient hypoxemia. The endoscope was quickly removed and the LMA was repositioned. The procedure was completed successfully without subsequent complication. There were no post-procedure complaints of inadequate sedation or oropharyngeal discomfort. Conclusion: It is safe and feasible to use the LMA to protect the airway during deep conscious sedation while inserting a large diameter endoscope alongside the LMA. Further study is warranted to determine whether the LMA confers a safety benefit over the standard nasal cannula and whether this technique will make possible the safe administration of propofol-based sedation by non-anesthesiologists.
Magne Kjerulf Hansen - One of the best experts on this subject based on the ideXlab platform.
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anaesthesia of atlantic halibut hippoglossus hippoglossus effect of pre anaesthetic sedation and importance of body weight and water temperature
Aquaculture Research, 2011Co-Authors: Inger Hilde Zahl, Anders Kiessling, Ole Bent Samuelsen, Magne Kjerulf HansenAbstract:The efficacy of the anaesthetic agents benzocaine, metacaine (MS-222), metomidate, 2-phenoxyethanol, quinaldine and isoeugenol was studied in Atlantic halibut (Hippoglossus hippoglossus). Fish with an average body weight of 33 g were anaesthetized at 8 °C and fish with an average body weight of 1243 g were anaesthetized at 8 and 15 °C. Agents were tested individually and as combination anaesthesia comprising pre-anaesthetic sedation, followed by anaesthesia. Induction and recovery times varied in relation to the body weight and water temperature. Large fish had longer induction times and shorter recovery times, and displayed reduced responsiveness to handling compared with small fish. A higher temperature resulted in shorter induction times, longer recovery times and increased responsiveness to handling. Lower dosages were used for all agents in combination anaesthesia. In small fish, this had no effect on the induction times but resulted in shorter recovery times and reduced responsiveness to handling. In large fish, combination anaesthesia resulted in shorter induction times whereas no uniform trend in recovery times and no differences in responsiveness to handling were observed. Neither individual agents nor combinations blocked all reflex reactions to external stimulation in all fish of any treatment group. MS-222 and benzocaine, used separately or in combination anaesthesia, were the most effective agents in reducing reflex reactions.
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anaesthesia of atlantic cod gadus morhua effect of pre anaesthetic sedation and importance of body weight temperature and stress
Aquaculture, 2009Co-Authors: Inger Hilde Zahl, Anders Kiessling, Ole Bent Samuelsen, Magne Kjerulf HansenAbstract:Abstract The efficacy of the anaesthetic agents benzocaine, metacaine (MS-222), metomidate and 2-phenoxyethanol was studied in Atlantic cod ( Gadus morhua ) with average body weights of 10 ± 4 g, 99 ± 33 g and 1022 ± 274 g at water temperatures of 8 °C and 16 °C. The agents were tested individually and as combination anaesthesia comprising pre-anaesthetic sedation with a low dosage of metomidate or 2-phenoxyethanol followed by anaesthesia with benzocaine or MS-222. All agents were administered through bath immersion with an exposure time of 5 min. The different treatments resulted in average induction and recovery times ranging from 52 ± 6 s to 182 ± 16 s and 77 ± 26 s to 659 ± 46 s respectively. Induction and recovery times varied in relation to water temperature and were generally shorter at 16 °C for all weight groups and treatments compared to 8 °C. For benzocaine and MS-222 induction and recovery times were found to increase with increasing body weight. For metomidate the recovery time increased with increasing weight whereas there were no weight related differences in induction time. No differences in either induction or recovery times associated to body weight were found for 2-phenoxyethanol. Acute stress prior to anaesthesia with MS-222 resulted in significantly shorter induction time and prolonged recovery time, as well as deeper anaesthetised fish. The dosage of MS-222 had to be reduced in order to avoid mortality in fish subjected to acute stress. Combination anaesthesia allowed a reduction of the dosages used for inducing anaesthesia and produced markedly reduced recovery times compared to agents administered individually.
Marilee M. Burnside - One of the best experts on this subject based on the ideXlab platform.
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Increased upper airway collapsibility in children with obstructive sleep apnea during wakefulness.
American journal of respiratory and critical care medicine, 2003Co-Authors: David Gozal, Marilee M. BurnsideAbstract:Upper airway collapsibility (UAC) is increased in children with sleep-disordered breathing (SDB), but during wakefulness, active neural processes preserve upper airway patency, such that measurement of upper airway dynamics using acoustic pharyngometry may contribute to diagnostic accuracy in snoring children. Upper airway cross-sectional area obtained from acoustic pharyngometry measurements was assessed in 247 children referred for evaluation of suspected SDB and control subjects, before and after application of Cetacaine 1% spray to the pharyngeal introitus under visual inspection. UAC was determined from the precentage change in cross-sectional area after topical anesthesia. UAC measurements were reproducible 1 week apart in both control subjects and patients with SDB (p < 0.005). A UAC less than or equal to -30% exhibited high sensitivity and specificity in identification of all children with obstructive apnea-hypopnea index greater than 5/hour total sleep time in a prospective initial sample of 54 children and in a subsequent post hoc sample of 94 snoring children. Thus, upper airway dynamic testing during wakefulness in response to a topical airway anesthetic may provide a useful clinical adjunct to the evaluation of snoring children, with more accurate identification of those children with SDB.
Anders Kiessling - One of the best experts on this subject based on the ideXlab platform.
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anaesthesia of atlantic halibut hippoglossus hippoglossus effect of pre anaesthetic sedation and importance of body weight and water temperature
Aquaculture Research, 2011Co-Authors: Inger Hilde Zahl, Anders Kiessling, Ole Bent Samuelsen, Magne Kjerulf HansenAbstract:The efficacy of the anaesthetic agents benzocaine, metacaine (MS-222), metomidate, 2-phenoxyethanol, quinaldine and isoeugenol was studied in Atlantic halibut (Hippoglossus hippoglossus). Fish with an average body weight of 33 g were anaesthetized at 8 °C and fish with an average body weight of 1243 g were anaesthetized at 8 and 15 °C. Agents were tested individually and as combination anaesthesia comprising pre-anaesthetic sedation, followed by anaesthesia. Induction and recovery times varied in relation to the body weight and water temperature. Large fish had longer induction times and shorter recovery times, and displayed reduced responsiveness to handling compared with small fish. A higher temperature resulted in shorter induction times, longer recovery times and increased responsiveness to handling. Lower dosages were used for all agents in combination anaesthesia. In small fish, this had no effect on the induction times but resulted in shorter recovery times and reduced responsiveness to handling. In large fish, combination anaesthesia resulted in shorter induction times whereas no uniform trend in recovery times and no differences in responsiveness to handling were observed. Neither individual agents nor combinations blocked all reflex reactions to external stimulation in all fish of any treatment group. MS-222 and benzocaine, used separately or in combination anaesthesia, were the most effective agents in reducing reflex reactions.
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anaesthesia of atlantic cod gadus morhua effect of pre anaesthetic sedation and importance of body weight temperature and stress
Aquaculture, 2009Co-Authors: Inger Hilde Zahl, Anders Kiessling, Ole Bent Samuelsen, Magne Kjerulf HansenAbstract:Abstract The efficacy of the anaesthetic agents benzocaine, metacaine (MS-222), metomidate and 2-phenoxyethanol was studied in Atlantic cod ( Gadus morhua ) with average body weights of 10 ± 4 g, 99 ± 33 g and 1022 ± 274 g at water temperatures of 8 °C and 16 °C. The agents were tested individually and as combination anaesthesia comprising pre-anaesthetic sedation with a low dosage of metomidate or 2-phenoxyethanol followed by anaesthesia with benzocaine or MS-222. All agents were administered through bath immersion with an exposure time of 5 min. The different treatments resulted in average induction and recovery times ranging from 52 ± 6 s to 182 ± 16 s and 77 ± 26 s to 659 ± 46 s respectively. Induction and recovery times varied in relation to water temperature and were generally shorter at 16 °C for all weight groups and treatments compared to 8 °C. For benzocaine and MS-222 induction and recovery times were found to increase with increasing body weight. For metomidate the recovery time increased with increasing weight whereas there were no weight related differences in induction time. No differences in either induction or recovery times associated to body weight were found for 2-phenoxyethanol. Acute stress prior to anaesthesia with MS-222 resulted in significantly shorter induction time and prolonged recovery time, as well as deeper anaesthetised fish. The dosage of MS-222 had to be reduced in order to avoid mortality in fish subjected to acute stress. Combination anaesthesia allowed a reduction of the dosages used for inducing anaesthesia and produced markedly reduced recovery times compared to agents administered individually.
Jonathan Cohen - One of the best experts on this subject based on the ideXlab platform.
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7207 Laryngeal mask airway: a novel means of maintaining a patent airway during endoscopy in patients receiving deep conscious sedation.
Gastrointestinal Endoscopy, 2000Co-Authors: Jonathan Cohen, Jonathan M. Reiber, Irene P. OsbornAbstract:Background: Aspiration, hypoxemia and hypoventilation are uncommon but serious complications during endoscopy. The risk of airway problems increases as higher doses of medications are used for sedation. The Laryngeal Mask Airway (LMA) is an FDA-approved device which is placed perorally and rests with its tip in the inferior recess of the hypopharynx. It is used as an alternative to endotracheal intubation. An ambu bag may be attached to the LMA for manual ventilation, if needed. Methods: We tested the feasibility of using the LMA to keep the airway open during concurrent passage of a therapeutic duodenoscope (diameter 13 mm). Patients were identified who were expected to require high doses of sedatives to undergo therapeutic ERCP. Individuals at high risk for aspiration were excluded. All patients received topical pharyngeal anesthesia with Cetacaine spray. After the administration of sedation, the LMA (diameter 15 mm) was placed by an anesthesiologist with the patient in the supine position. The patient was turned to the prone position and the duoedenoscope was passed by the staff gastroenterologist. Difficulty intubating the esophagus, friction encountered during the procedure as the endoscope was manipulated and episodes of hypoxia were recorded. Patients were interviewed after all procedures. Results: Ten patients underwent 12 ERCP's using propofol-based sedation regimens. An additional case was done using anesthetic gasses. The mean age was 51.4 years. The mean ASA class was 2.8. All procedures were successfully performed without oropharyngeal trauma. In each case, the endoscope was inserted around the LMA without dislodging the distensible rubber seal. Minimal friction between the LMA and the endoscope was appreciated by the endoscopist. In one patient, the seal loosened during the procedure leading to transient hypoxemia. The endoscope was quickly removed and the LMA was repositioned. The procedure was completed successfully without subsequent complication. There were no post-procedure complaints of inadequate sedation or oropharyngeal discomfort. Conclusion: It is safe and feasible to use the LMA to protect the airway during deep conscious sedation while inserting a large diameter endoscope alongside the LMA. Further study is warranted to determine whether the LMA confers a safety benefit over the standard nasal cannula and whether this technique will make possible the safe administration of propofol-based sedation by non-anesthesiologists.