With the use of constant flow, end-inspiratory airway occlusion, respiratory system resistance (Rrs) can be partitioned into a flow resistive component (Rint) and an additional component (deltaR), reflecting viscoelasticity and time constant inequality. Similarly, respiratory system elastance (Edyn) can be partitioned into static elastance (Est) and elastance due to viscoelasticity and time constant inequality (deltaE). We measured Rrs and Edyn and their subdivisions (Rint and deltaR, Est and deltaE, respectively) and studied their flow and volume dependence in eight otherwise healthy children (median age 3.6 y; range 1.9-5.2 y) undergoing general anesthesia for oral rehabilitation. With a constant inspiratory flow (VI) of approximately 15 mL/s/kg and tidal volume of 12 mL/kg, the mean values of Rrs, Rint, and deltaR were: 0.20, 0.11, and 0.10 cmH2O/mL/s.kg. Under the same conditions, the mean Est and deltaE were: 1.04 and 0.12 cmH2O/mL/kg. With increasing VI and under constant VT, deltaR decreased (p < 0.001) progressively. Rint also decreased paradoxically (p < 0.001). Hence, Rrs decreased (p < 0.001) with increasing VI. Est decreased (p < 0.001) with increasing VI, whereas delta E increased (p < 0.005). With increasing VT and under constant VI, Rint decreased (p < 0.001) and deltaR tended to increase (p = 0.058); Rrs did not change. With increasing VT under constant VI, both Est and deltaE decreased (p < 0.001 and p = 0.001, respectively). Thus, in contrast to the findings in adults, Rint and Est decreased in children with increasing flow and under constant tidal volume, probably reflecting decreased functional residual capacity in anesthetized children, compared with adults. The flow and volume dependence of deltaR and deltaE were similar to those in adults, whereas Rrs did not necessarily follow the direction of changes of deltaR.

This report describes the case of a 47-year-old man who shot himself in the left side of the chest in an attempted suicide, and was transferred to the hospital. Two gunshot wounds were found in the left side of the chest and the back. CT scans revealed left hemopneumothorax, the accumulation of pericardial blood, and lacerations of the heart and the spleen. Emergency thoracotomy and laparotomy were performed. There was a contusion of the left lung and lacerations of the left ventricular free wall, the diaphragm, and the spleen. The laceration of the heart was repaired by 3 pairs of mattress sutures with felt strips, and covered with fibrin glue and a TachoComb(®) tissue sealing sheet without the use of cardiopulmonary bypass. The patient was discharged on foot on the 18th postoperative day. Such patients can only be saved with an efficient emergency medical-care system including quick transportation, and close cooperation of the hospital staff.

Although tracheal agenesis is presently considered to be a rare and fatal anomaly, an increasing number of institutions have been reporting such cases. Reported herein, is a clinical and necropsy report of a premature infant whose tracheal agenesis was associated with broncho-esophageal fistulas and an imperforate anus. Accidental esophageal intubation enabled a perineal anoplasty to be performed under general anesthesia and allowed him to survive for 14 days.

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