Tracheobronchial secretions

Halothane (Fluothane) is a volatile liquid given by inhalation for induction and maintenance of anesthesia Induction and recovery from anesthesia are rapid, and the depth of anesthesia can be rapidly altered. Halothane does not irritate the respiratory tract, and an increase in tracheobronchial secretions usually does not occur. Halothane produces moderate muscle relaxation, but skeletal muscle relaxants may be used in certain types of surgeries. This anesthetic may be given with a mixture of nitrous oxide and oxygen. 

Dimers and polymers of IgA are found in the various external secretions such as gastrointestinal, colostrum, seminal, and vaginal secretions, saliva, tears, nasal, bile, urine, and tracheobronchial secretions. Parotid saliva has an IgGrIgA ratio of about 0.01 compared to 4.5 for serum (T5). Four types of polypeptide chains have been identified in S IgA the light chain, MW 22,500 the hea y chain, MW 55,000 the secretory component (SC), MW 60,000 and the joining (J) chain, MW 20,000. 

Mechanism of Action A cholinergic, parasympathomimetic, synthetic analog of acetylcholine that stimulates muscarinic, postganglionic parasympathetic receptors. TherapeuticEffect Results in smooth muscle contraction of the airways and increased tracheobronchial secretions. 

W. 5. Cbernick and G, J. Butau Composition of tracheobronchial secretions m cystic fibrosis oF the pancreas a nd broochlectuk Pediatries 24 739-743 (1959). 

Increased nasal and tracheobronchial secretions Cough Sneezing Bronchospasm Change in breathing rate Salivation... 

W. S. Chemick and G. J. Barbero. Composition of tracheobronchial secretions in cystic fibrosis of the pancreas a nd bronchiectasis. Pediatrics 24 739-745 (1959). 

W. S. Chernick, G. J. Barbero, and H. J. Eichel. In-vitro evaluation of effect of enzymes on tracheobronchial secretions from patients with cystic fibrosis. Pediatrics 27 589-596 (1961). 

IgA forms about 15-20% of total serum immunoglobulin where it occurs largely as a monomer. In a dimeric complex known as secretory IgA (slgA) it is the major antibody in seromucous secretions such as saliva, tracheobronchial secretions, colostrum, milk and genitourinary secretions. 

The influence of ACh and parasympathetic innervation on various organs and tissues is discussed in detail in Chapter 6. ACh and its analogs stimulate secretion by all glands that receive parasympathetic innervation, including the lacrimal, tracheobronchial, salivary, and digestive glands. The effects on the respiratory system, in addition to increased tracheobronchial secretion, include hronchoconstriction and stimulation of the chemoreceptors of the carotid and aortic bodies. When instilled into the eye, muscarinic agonists produce miosis (see Chapter 63). 

In addition to tracheobronchial secretions, bronchial smooth muscle is stimulated by the muscarinic agonists. Asthmatic patients respond with intense bronchoconstriction, secretions, and a reduction in vital capacity. These actions form the basis of the methacholine challenge test used to diagnose airway hyperreactivity. 

Chemical warfare agents that had been manufactured in the 1950s were being stored at a military installation. Several civilian workers at the facility began to feel unwell, with symptoms that included dyspnea, abdominal cramps, and diarrhea. They also had copious nasal and tracheobronchial secretions. Which type of toxic compound is most likely to be the cause of these effects ... 

These effects produced by anli-ChEs may be of clinical value (e.g, lowering of lOP in cases of glaucoma). In addition to their potentially lethal effects caused by paralysis of respiratory muscles, bronchoconstriclion, increased tracheobronchial secretions, and depression of the CNS respiratory center, exposure to low concentrations can... 

Z Maintenance of an adequate airway and breathing is necessary if there is obstruction resulting from bronchial secretions and bronclio.spasm. This may require the use of an oral airway (or insertion of an endotracheal tube if medical assistance is available) and assisted ventilation (e.g., mask with manual inflator). Oxygen is valuable because of the potential for hypoxia resulting from airway obstruction secondary to increa.sed tracheobronchial secretions and bronchospasm (Munidasa et al.. 2004). When hospitalized, endotracheal intubation and assisted ventilation may be required (Proudfooi and Vale, 1996),... 

Finkelstein etai. (1989) performed a noncontrolled prospective study of severe OP poisoning, in this study of 53 adult patients, atropine 2 mg by intravenous bolu.s, followed by the same dose at intervals of 10 min or more, was administered and the dose was adjusted as necessary to control tracheobronchial secretions and bronchospasm. All 53 patients w ere mechanically ventilated and obidoxime wa.s also given. Although it is not po.ssiblc to quantify any beneficial effect from atropine administration alone, atropine appeared to counteract the muscarinic features. 

Shlmamoto and Honjo concluded from animal studies that bromhexlne affects tracheobronchial secretions by an action on central nervous system structures, probably In the areas of the emetic center In the medulla oblongata occurring both as a direct effect and Indirectly via stimulation of the gastric mucous membrane. Other animal tests Indicated bronchial secretions were Increased by bromhexlne as a result of an Improved permeability ratio between the bronchial mucous membrane and Its blood supply. The lytic effect of bromhexlne on human bronchial mucosa, observed vitro by electron microscopy, appears due to Increased secretion... 

Elman LB, Dubin RM, Kelley M, et al. Management of oropharyngeal and tracheobronchial secretions in patients with neurologic disease. J Palliat Med 2005 8(6) 1150-1159. 

Biochemical studies have demonstrated the presence of surface-active components, predominantly phospholipids, in airway secretions (42). Bernhard et al. (43,44) studied the conductive airway phospholipids in the tracheobronchial secretions of adult pigs and compared their results with analyses of bronchoalveolar lavage (B AL) fluid, tracheobronchial epithelium, and lung parenchyma. The composition of the PC and PL molecular species of the tracheal aspirates was similar... 

Slomiany et al. (45) reported the lipid and protein composition in tracheobronchial secretions from normal individuals and patients with cystic fibrosis. In the normal bronehial secretions, the total phospholipid was only about half as mueh as has been reported for normal alveolar surfactant (46). The largest differ-enees were in the amounts of lysophosphatidylcholine, 29.5 versus 0.4%, sphingomyelin, 15.8 versus 3.7%, and phosphatidylethanolamine, 12.4 versus 2.6%, respectively. The differences in the surfactant composition between alveolar and airway surfaetant may be due to the addition of mucus from goblet cells and submucosal mucous glands (47), and the contribution of Clara cells (48). 

Slomiany A, Murty VLN, Aono M, Snyder CE, Herp A, Slomiany BE. Lipid composition of tracheobronchial secretions from normal individuals and patients with cystic fibrosis. Biochim Biophys Acta 1982 710 106-111. 

Girod S, Galabert C, Lecuire A, Zahm J-M, Puchelle E. Phospholipid composition and surface-active properties of tracheobronchial secretions from patients with cystic fibrosis and chronic obstructive pulmonary disease. Pedeatr Pulmonal 1992 13 22-27. 

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