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We describe a new technique for diagnostic fiberoptic bronchoscopic procedures under general anesthesia. The technique of inflation via nasotracheal catheter, which consists of using intermittent high inflating pressure for ventilation by passing a double catheter through the nose to the glottis and into the trachea, gave very satisfactory ventilation, with high levels of oxygen in the blood. Intratracheal pressure was monitored continuously to guarantee safety, and pulmonary function was assessed before and after the procedure. Continuous electrocardiographic monitoring was used, and blood gas levels were determined at very frequent intervals. The use of infusions of methohexitone and succinylcholine (suxamethonium) provided adequate safe anesthesia and prompt recovery, with absence of recall of the procedure.

Most critically ill patients have a high catabolic rate to which sepsis, restlessness, and the hormonal stress response may be contributing factors. This has been confirmed by measurement of oxygen consumption. (Vo2) as a reflection of energy expenditure. While acutely ill patients may adapt to this situation, one of their adaptative mechanisms is to increase their minute ventilation. Increased minute ventilation increases the work of breathing and the oxygen cost of respiratory work. The higher the minute ventilation, the higher the percentage of oxygen consumed for respiratory work. In order to evaluate the magnitude of these factors, 20 acutely ill patients (severe burns, multiple injuries, and comatose states) were studied by measurements of Vo2 during mechanical ventilation and after disconnection from the ventilator for short periods of time; i.e., 20 min. Paired tests, on and off ventilator, were performed successively three to five times on each patient ventilated for various reasons, but not those in respiratory distress. The tests were mainly performed during the period of weaning from mechanical ventilation. A reproducible increase in Vo2 was observed in most patients when they were disconnected from mechanical ventilation and allowed to breathe spontaneously. The observed reduction of Vo2 with mechanical ventilation was interpreted as a direct result of mechanical ventilation. The possibility of extending the indications for mechanical ventilation in hypercatabolic state patients without acute respiratory failure is discussed.

To monitor variations of energy metabolism on-line a system which accurately measures VO2 and VCO2 is described. The calculation of the energy metabolism usually requires knowledge of nitrogen production. This paper presents a formula that allows calculation on-line on the energy metabolism with a maximum relative error of 4% as function of VO2 and VCO2 only. Some experimental results in normal subjects are presented.

umerous techniques for mechanical ventilation during bronchoscopy performed with general anesthesia have been described.14 Ventilation using a 17enturi injector system described initially by Sanders5 and modified by others has gained wide ;~c.ceptance.~-~ Rcthune et alQ attempted to establish guidelines for bronchoscope and injector sizes. Jardine et a1.I0 using a lung model, have analyzed the influence of "patient" compliance and airway resistance on inspiratory oxygen concentrations 'and tidal volume. The purpose of the present study was to establish the optimal ratio between injector and bronchoscope sizes in dogs, using respiratory para~rleters as guidelines.

A case of bilateral subtotal thyroidectomy with acute respiratory distress is presented. The multiple etiological factors involved in causing this life-threatening emergency are discussed. Bilateral recurrent laryngeal nerve palsy was successfully treated conservatively by nasotracheal intubation. Tracheostomy was not necessary.

Clinical evaluation of High Frequency Positive Pressure Ventilation (H.F.P.P.V.) was made in 12 morbid obese patients undergoing elective gastric bypass or gastric partition operation. A conventional respirator of the Air-Shields type was used working at a frequency varying between 60-90 min and I.E. ratio 1:3. After induction of anesthesia serial measurements of arterial blood gases were performed during conventional Intermittent Positive Pressure Ventilation (I.P.P.V.) and H.F.P.P.V. the patient being his own control. No significant differences between the two methods of ventilation were found with respect to arterial systemic blood pressure, arterial oxygen and carbon dioxide tensions. The relatively low intra-tracheal pressures during H.F.P.P.V. were adequate to produce efficient oxygenation and ventilation with optimal conditions for the surgical intervention.

A case of self-administrated injection of a solution of méthylphénidate (Rilatine) into the brachial artery is described. Intensive treatment which was started within 12 hours including repeated stellate blocks, intraarterial and intravenous injections of vasodilators and hyperbaric oxygen leaded to limited loss of the tips of the fingers. The increase hasards of intraarterial injections of dissolved tablets in addicts enhance us to investigate further on earlier and more energetic treatment in these cases.

We describe a technique of anaesthesia for microlaryngeal surgery which we have found satisfactory. Inflation of oxygen through a noso-tracheal catheter provided very satisfactory ventilation with high oxygen levels in contrast to other reports. The intratracheal pressure was intermittently monitored to ensure safety. Continuous infusion of Methohexitone and suxamethonium provided adequate safe anaesthesia, prompt recovery, and absence of awareness. The results of pulmonary function tests undertaken preoperatively and postoperatively were mainly identical, showing no gross deleterious effect with this method of anaesthesia.