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British Medical Journal Feb 1959
Topics: Asphyxia; Humans; Nitrogen
PubMed: 13629050
DOI: 10.1136/bmj.1.5121.559 -
Canadian Medical Association Journal Aug 1947
Topics: Asphyxia; Asphyxia Neonatorum; Humans; Infant, Newborn; Resuscitation
PubMed: 20253848
DOI: No ID Found -
The Journal of Physiology Sep 2016A distinctive pattern of recurrent rapid falls in fetal heart rate, called decelerations, are commonly associated with uterine contractions during labour. These brief... (Review)
Review
A distinctive pattern of recurrent rapid falls in fetal heart rate, called decelerations, are commonly associated with uterine contractions during labour. These brief decelerations are mediated by vagal activation. The reflex triggering this vagal response has been variably attributed to a mechanoreceptor response to fetal head compression, to baroreflex activation following increased blood pressure during umbilical cord compression, and/or a Bezold-Jarisch reflex response to reduced venous return from the placenta. Although these complex explanations are still widespread today, there is no consistent evidence that they are common during labour. Instead, the only mechanism that has been systematically investigated, proven to be reliably active during labour and, crucially, capable of producing rapid decelerations is the peripheral chemoreflex. The peripheral chemoreflex is triggered by transient periods of asphyxia that are a normal phenomenon associated with all uterine contractions. This should not cause concern as the healthy fetus has a remarkable ability to adapt to these repeated but short periods of asphyxia. This means that the healthy fetus is typically not at risk of hypotension and injury during uncomplicated labour even during repeated brief decelerations. The physiologically incorrect theories surrounding decelerations that ignore the natural occurrence of repeated asphyxia probably gained widespread support to help explain why many babies are born healthy despite repeated decelerations during labour. We propose that a unified and physiological understanding of intrapartum decelerations that accepts the true nature of labour is critical to improve interpretation of intrapartum fetal heart rate patterns.
Topics: Animals; Asphyxia; Baroreflex; Female; Fetus; Head; Heart Rate, Fetal; Humans; Hypovolemia; Labor, Obstetric; Pregnancy
PubMed: 27328617
DOI: 10.1113/JP271205 -
Epilepsia Jan 2016Sudden unexpected death in epilepsy (SUDEP) risk reduction remains a critical aim in epilepsy care. To date, only aggressive medical and surgical efforts to control... (Review)
Review
Sudden unexpected death in epilepsy (SUDEP) risk reduction remains a critical aim in epilepsy care. To date, only aggressive medical and surgical efforts to control seizures have been demonstrated to be of benefit. Incomplete understanding of SUDEP mechanisms limits the development of more specific interventions. Periictal cardiorespiratory dysfunction is implicated in SUDEP; postictal electroencephalography (EEG) suppression, coma, and immobility may also play a role. Nocturnal supervision is protective against SUDEP, presumably by permitting intervention in the case of a life-threatening event. Resuscitative efforts were implemented promptly in near-SUDEP cases but delayed in SUDEP deaths in the Mortality in Epilepsy Monitoring Unit Study (MORTEMUS) study. Nursing interventions--including repositioning, oral suctioning, and oxygen administration--reduce seizure duration, respiratory dysfunction, and EEG suppression in the epilepsy monitoring unit (EMU), but have not been studied in outpatients. Cardiac pacemakers or cardioverter-defibrillator devices may be of benefit in a few select individuals. A role for implantable neurostimulators has not yet been established. Seizure detection devices, including those that monitor generalized tonic-clonic seizure-associated movements or cardiorespiratory parameters, may provide a means to permit timely periictal intervention. However, these and other devices, such as antisuffocation pillows, have not been adequately investigated with respect to SUDEP prevention.
Topics: Asphyxia; Cardiac Pacing, Artificial; Cardiopulmonary Resuscitation; Death, Sudden; Deep Brain Stimulation; Defibrillators, Implantable; Electroencephalography; Epilepsy; Humans; Implantable Neurostimulators; Monitoring, Physiologic; Oxygen Inhalation Therapy; Pacemaker, Artificial; Patient Positioning; Resuscitation; Suction
PubMed: 26749014
DOI: 10.1111/epi.13231 -
The Journal of Physiology Dec 2018We evaluated the effect of magnesium sulphate (MgSO ) on seizures induced by asphyxia in preterm fetal sheep. MgSO did not prevent seizures, but significantly reduced...
KEY POINTS
We evaluated the effect of magnesium sulphate (MgSO ) on seizures induced by asphyxia in preterm fetal sheep. MgSO did not prevent seizures, but significantly reduced the total duration, number of seizures, seizure amplitude and average seizure burden. Saline-asphyxia male fetuses had significantly more seizures than female fetuses, but male fetuses showed significantly greater reduction in seizures during MgSO infusion than female fetuses. A circadian profile of seizure activity was observed in all fetuses, with peak seizures seen around 04.00-06.00 h on the first and second days after the end of asphyxia. This study is the first to demonstrate that MgSO has utility as an anti-seizure agent after hypoxia-ischaemia. More information is needed about the mechanisms mediating the effect of MgSO on seizures and sexual dimorphism, and the influence of circadian rhythms on seizure expression.
ABSTRACT
Seizures are common in newborns after asphyxia at birth and are often refractory to anti-seizure agents. Magnesium sulphate (MgSO ) has anticonvulsant effects and is increasingly given to women in preterm labour for potential neuroprotection. There is limited information on its effects on perinatal seizures. We examined the hypothesis that MgSO infusion would reduce fetal seizures after asphyxia in utero. Preterm fetal sheep at 0.7 gestation (104 days, term = 147 days) were given intravenous infusions of either saline (n = 14) or MgSO (n = 12, 160 mg bolus + 48 mg h infusion over 48 h). Fetuses underwent umbilical cord occlusion (UCO) for 25 min, 24 h after the start of infusion. The start time for seizures did not differ between groups, but MgSO significantly reduced the total number of seizures (P < 0.001), peak seizure amplitude (P < 0.05) and seizure burden (P < 0.005). Within the saline-asphyxia group, male fetuses had significantly more seizures than females (P < 0.05). Within the MgSO -asphyxia group, although both sexes had fewer seizures than the saline-asphyxia group, the greatest effect of MgSO was on male fetuses, with reduced numbers of seizures (P < 0.001) and seizure burden (P < 0.005). Only 1 out of 6 MgSO males had seizures on the second day post-UCO compared to 5 out of 6 MgSO female fetuses (P = 0.08). Finally, seizures showed a circadian profile with peak seizures between 04.00 and 06.00 h on the first and second day post-UCO. Collectively, these results suggest that MgSO may have utility in treating perinatal seizures and has sexually dimorphic effects.
Topics: Animals; Asphyxia; Female; Fetal Hypoxia; Fetus; Ischemia; Magnesium Sulfate; Male; Neuroprotective Agents; Seizures; Sex Factors; Sheep; Time Factors; Umbilical Cord
PubMed: 29572829
DOI: 10.1113/JP275627 -
Psychiatria Polska Oct 2019The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published in 2013 has proved to be particularly interesting in the field of sexuality. It... (Review)
Review
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published in 2013 has proved to be particularly interesting in the field of sexuality. It introduced a number of significant changes in the definition of sexual norms, among them a widely discussed distinction between paraphilias and paraphilic disorders. The key criterion separating the abnormal sexual interests from the disordered ones is clinically significant distress resulting directly from sexual behavior and/or the risk of suffering or harm to another person as a result of one's sexual behavior. In the case of masochism - which addresses the phenomenon of suffering quite particularly - this distinction is troublesome. Using the example of autoerotic asphyxia - a behavior from the masochism spectrum - the authors critically examine the proposed DSM-5 method of defining the standards of sexual behavior. Interesting in this regard has been a comparison between autoerotic asphyxia and free diving - a nonsexual activity which, although also associated with possible loss of life by reduction of oxygen, has not been pathologized.
Topics: Asphyxia; Diagnostic and Statistical Manual of Mental Disorders; Humans; Hypoxia, Brain; Male; Paraphilic Disorders; Sexual Behavior
PubMed: 31955188
DOI: 10.12740/PP/OnlineFirst/78166 -
Resuscitation Mar 2023The International Commission for Mountain Emergency Medicine (ICAR MedCom) developed updated recommendations for the management of avalanche victims. (Review)
Review
INTRODUCTION
The International Commission for Mountain Emergency Medicine (ICAR MedCom) developed updated recommendations for the management of avalanche victims.
METHODS
ICAR MedCom created Population Intervention Comparator Outcome (PICO) questions and conducted a scoping review of the literature. We evaluated and graded the evidence using the American College of Chest Physicians system.
RESULTS
We included 120 studies including original data in the qualitative synthesis. There were 45 retrospective studies (38%), 44 case reports or case series (37%), and 18 prospective studies on volunteers (15%). The main cause of death from avalanche burial was asphyxia (range of all studies 65-100%). Trauma was the second most common cause of death (5-29%). Hypothermia accounted for few deaths (0-4%).
CONCLUSIONS AND RECOMMENDATIONS
For a victim with a burial time ≤ 60 minutes without signs of life, presume asphyxia and provide rescue breaths as soon as possible, regardless of airway patency. For a victim with a burial time > 60 minutes, no signs of life but a patent airway or airway with unknown patency, presume that a primary hypothermic CA has occurred and initiate cardiopulmonary resuscitation (CPR) unless temperature can be measured to rule out hypothermic cardiac arrest. For a victim buried > 60 minutes without signs of life and with an obstructed airway, if core temperature cannot be measured, rescuers can presume asphyxia-induced CA, and should not initiate CPR. If core temperature can be measured, for a victim without signs of life, with a patent airway, and with a core temperature < 30 °C attempt resuscitation, regardless of burial duration.
Topics: Humans; Iron-Dextran Complex; Asphyxia; Retrospective Studies; Avalanches; Prospective Studies; Hypothermia; Cardiopulmonary Resuscitation
PubMed: 36709825
DOI: 10.1016/j.resuscitation.2023.109708 -
Respiration; International Review of... 2017Capsule endoscope aspiration is an increasingly reported complication, potentially responsible for respiratory distress and asphyxia. This adverse event is primarily...
Capsule endoscope aspiration is an increasingly reported complication, potentially responsible for respiratory distress and asphyxia. This adverse event is primarily managed by rigid bronchoscopy when spontaneous expulsion does not occur. This complication is all the more detrimental to patients as it can delay or jeopardize further digestive exploration. We report direct repositioning of the capsule in the stomach at the same time as bronchoscopy, thus making second-line gastrointestinal endoscopy needless.
Topics: Aged; Asphyxia; Bronchi; Bronchoscopy; Capsule Endoscopes; Foreign Bodies; Humans; Male; Radiography, Thoracic; Respiratory Aspiration
PubMed: 28056462
DOI: 10.1159/000453587 -
The Journal of Physiology Dec 2012A resumption of, and escalation in, breathing efforts (hyperpnoea) reflexively accelerates heart rate (HR) and may facilitate cardiac and circulatory recovery from...
A resumption of, and escalation in, breathing efforts (hyperpnoea) reflexively accelerates heart rate (HR) and may facilitate cardiac and circulatory recovery from apnoea. We analysed whether this mechanism can produce a sustained rise in HR (tachycardia) when a sleeping infant is confronted by mild, rapidly worsening asphyxia, simulating apnoea. Twenty-seven healthy term-born infants aged 1-8 days rebreathed the expired gas for 90 s during quiet sleep to stimulate breathing and heart rate. To discriminate cardio-excitatory effects of central respiratory drive, lung inflation, hypoxia, hypercapnia and asphyxia, we varied the inspired O(2) level and compared temporal changes in response profiles as respiratory sensitivity to hypoxia and asphyxia 'reset' after birth. We demonstrate that asphyxia-induced hyperpnoea and tachycardia strengthen dramatically over the first week with different time courses and via separate mechanisms. Cardiac excitation by hypercapnia improves first, followed by a slower improvement in respiratory hypoxic drive. A rise in CO(2) consequently elicits stronger, longer lasting tachycardia than moderate increases in respiratory drive or lung expansion. We suggest that without a strong facilitating action of CO(2) on the immature heart, respiratory manoeuvres may be unable to reflexively counteract strong vagal bradycardia. This may increase the vulnerability of some infants to apnoea-asphyxia.
Topics: Asphyxia; Carbon Dioxide; Heart Rate; Humans; Infant, Newborn; Respiration
PubMed: 23006482
DOI: 10.1113/jphysiol.2012.239145 -
Neonatology 2022The brain magnetic resonance imaging (MRI) result is a major predictor for the outcome of term infants with perinatal asphyxia who underwent therapeutic hypothermia. In...
INTRODUCTION
The brain magnetic resonance imaging (MRI) result is a major predictor for the outcome of term infants with perinatal asphyxia who underwent therapeutic hypothermia. In daily practice, no uniform method is used to assess these images.
PURPOSE
The aim of this study was to determine which MRI-score best predicts adverse outcome at 24 months of age and has the highest inter-rater reliability.
METHODS
Four MRI scoring systems for term infants with perinatal asphyxia were selected: Rutherford score, Trivedi score, Weeke score, and NICHD NRN score. Experienced blinded raters retrospectively evaluated the brain MR Images of 161 infants using all four scoring systems. Long-term outcome (the composite outcome death or adverse outcome, and its separate components) were routinely assessed by standardized testing at the age of 24 months. The predictive accuracy was assessed by logistic regression analyses and expressed as area under the ROC curve (AUC). The inter-rater reliability of the scores was calculated by the weighted Kappa or intraclass correlation. A sensitivity analysis using only high-quality MRI scans was performed.
RESULTS
All four MRI scoring systems demonstrated an AUC of >0.66 for the prediction of adverse outcome and ≥0.80 for the prediction of death. The inter-rater reliability analyses demonstrated the highest reliability for the Weeke and Trivedi scores. When only assessing the high-quality scans, the AUC increased further.
CONCLUSION
All four MRI brain scores proved reliable predictors for an adverse outcome at 24 months of age. The Weeke and Trivedi score demonstrated the highest inter-rater reliability. The use of high-quality MRI further improved prediction.
Topics: Asphyxia; Asphyxia Neonatorum; Brain; Child, Preschool; Female; Humans; Hypothermia, Induced; Infant; Infant, Newborn; Magnetic Resonance Imaging; Pregnancy; Reproducibility of Results; Retrospective Studies
PubMed: 35358976
DOI: 10.1159/000522629