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March 2021

The Anæsthetist's Viewpoint on the Treatment of Respiratory Complications in Poliomyelitis During the Epidemic in Copenhagen 1952.

Journal/Book: Reprinted from PROCEEDINGS OF THE ROYAL SOCIETY OF MEDICINE January 1954 Vol. 47 No. 1 pp. 67-74 (Section of Epidemiology and Preventive Medicine pp. 1-8).. 1954;

Abstract: By Dr. BJØRN IBSEN Consultant Anæsthetist Blegdam Hospital Copenhagen Denmark On August 25 1952 I was called in as anæsthetist for consultation by Professor Lassen in the Epidemiological Hospital of Copenhagen. Within the preceding three weeks there had been 31 patients with bulbar poliomyelitis treated in respirators-tank as well as cuirass. 27 had died. Four patients were seen in the autopsy room that day. One of them-a 12-year-old boy-had died in a respirator with a blood pressure of 160 and a bicarbonate level in the serum far above the normal level. The lungs did not appear to be sufficiently atelectatic to make adequate ventilation impossible. With enthusiastic encouragement from Professor Lassen I tried to demonstrate an a patient how sufficient ventilation could be administered without the help of a respirator. A patient in a very bad condition was chosen. She was a 12-year-old girl who had paralysis of all four extremities. She had atelectasis of the left lung and was gasping for air and drowning in her own secretions. Her temperature was 40.2° C. She was cyanotic and sweating. A tracheotomy was done immediately under local anæsthesia and a cuffed endotracheaI tube put in place through the tracheotomy. During this procedure she became unconscious. A to-and-fro absorption system was connected directly to the tube with good endotracheal suction. Even then it was impossible to inflate the lungs partly due to secretions and partly due to bronchospasm. In this desperate situation I gave her 100 mg. Pentothal i.v. in the hope that I could stop her struggling. She collapsed her own respiration stopped and I found that I could now inflate her lungs. Shortly after this a device for continuous measurement of the carbon-dioxide concentration in the air from one of the main bronchi-a Brinkman Carbovisor-and an Oximeter of the Millikan type was put to work. By these means it was shown how under-ventilation gave rise to a CO2 accumulation-even when full oxygenation of the blood was maintained with pure oxygen. ... ___MH

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