Agressologie: revue internationale de physio-biologie et de pharmacologie appliquees aux effets de l'agression最新文献

Scoliosis surgery in the adolescent is prolonged, painful and haemorrhagic. There are neurological risks and surveillance of the medulla is necessary throughout surgery. An anterior (Dwyer, Zielke) or posterior (Harrington, Cotrel-Dubousset, Luque) approach to the spinal column cas used. Surgery using a posterior approach is the more haemorrhagic. The haemorrhage is increased by poor positioning of the patient, by the duration of surgery and by taking the bone graft. Constant care should be given to blood economy, using controlled hypotension, haemodilution and peroperative autotransfusion of lost blood (Cell-Saver). The anaesthetic should provide excellent analgesic effects and must be compatible with regain of consciousness during surgery and/or or the use of evoked potential techniques. Complications at that time are those of the circulation and those of neurological origin and linked with hypothermia. In the presence of haemorrhage, the maintenance of total blood volume is difficult when there is cardiopathy (myopathy). Neurological complications should be detected sufficiently early for them to be reversible (sensori-motor evoked potentials and/or "wake-up test"). Hypothermia is constant and requires the systematic use of a heated mattress, a heated humidifier and the heating of infusions. The postoperative complications are respiratory in origin and are especially associated with neuro-muscular disease (postoperative artificial ventilation). The per- and postoperative difficulties demonstrate the importance of the preoperative examination and of the preparation of the operation (respiratory preparation). Finally, staged autotransfusion should be used, when possible, and should be part of the techniques of blood economy in a true transfusion strategy.

The most satisfactory method of prone positioning for the posterior approach to the spine and posterior fossa has been influenced by the necessity of providing good operating condition: prone position without abdominal and thoracic compression with a patient's head in the neutral position. Communication between the cava veins and the vertebral venous plexus explain that induce positioning can produce an excessive venous intraoperative bleeding with decreased surgical visibility. Furthermore venous return to the heart decreased resulting in some degree of impaired cardiac output. Hemodynamic disturbances of cerebral or spinal cord bloods flows can occurred.

Spinal anesthesia (SA) for lumbar disk surgery in the genu-pectoral position (GP) has been proposed as an alternative to general anesthesia (GA). This study compares the haemodynamic effects of GP in two groups of patients undergoing either SA (n = 43) or GA (n = 40). Mean arterial pressure (MAP) and heart rate (HR) were recorded before and after GP. MAP and HR were significantly lower in the GA group after GP. We conclude that SA during GP for lumbar disk surgery is haemodynamically well tolerated.

Anaesthesia in patients with malformative and degenerative abnormalities of cervical spine poses a number of specific problems. A crucial point is the indispensable evaluation and observation before and during anaesthesia. Somatosensory evoked potentials being used to monitor nervous system pathways at risk during surgical procedures the effect of anaesthetic agents on these parameters are to be well known. Some pathologies are liable to per and postoperative specific risks breeding complications.

Lumbar disc hernia is a frequent pathology whose treatment remains essentially surgical. The type of anesthesia can be general anesthesia with intubation and controlled ventilation, both mandatory due to the position, peridural or spinal anesthesia. The usual position is knee-chest position which impairs circulation and ventilation if some precaution are not taken. Spinal anesthesia has been chosen in more than 40% of the patients by Lille CHU Team. This choice is justified by the important level of satisfaction of the patients and the absence of complications due to the anesthesia in a series of 1871 consecutive spinal anesthesia for lumbar disc surgery.

The trans-oral approach is a well codified and classical technique in neurosurgery. When correctly performed, this procedure gives excellent results in selected indications, such as: mechanical decompression of ondotoïdal vicious callus and more particularly, malformations of the craniovertebral function. This approach is also used for extirpation of C1, C2 and inferior clivus tumors. The complications of this technique are mainly septic, and must be prevented by appropriate pre and post-operative nursing.