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

The question of head trauma reasons, and the shock of traditional family and therapeutic references, make the authors examine clinic coma evolution till awakening. From signs of libidinal values collected by care-team, another way during coma and till life recovery, is rebuilt.

This study was undertaken to determine whether alfentanil (A) or sufentanil (S) associated with propofol (P) or etomidate (E) can abolish or attenuate the hemodynamic response to laryngoscopy and orotracheal intubation in ASA I or II patients, during induction of anesthesia for lumbar spinal surgery. Eighty patients were randomly divided into four groups. Group I (AE) received alfentanil 30 micrograms/kg and etomidate 0.3 mg/kg; group II (AP) received alfentanil 30 micrograms/kg and propofol 1.5 mg/kg; group III (SE) received sufentanil 0.3 microgram/kg and etomidate 0.3 mg/kg; group IV (SP) received sufentanil 0.3 microgram/kg and propofol 1.5 mg/kg. In each group, narcotic and hypnotic were given respectively five minutes and three minutes before laryngoscopy. The intubation was facilitated by vecuronium 0.1 mg/kg. The sequence of laryngoscopy and orotracheal intubation was always performed in less than 20 seconds. The anesthesia was maintained by O2/N2O in IPPV (TV = 10 ml/kg; respiratory rate 12). Heart rate, systolic, diastolic and mean blood pressure were recorded at the following times: on arrival in the operating room (T-5), 3 minutes before laryngoscopy (T-3), just at laryngoscopy (T0) and 1 (T1), 3 (T3), 54 (T5) minutes after intubation. The comparison of baseline values (T-5) with T1 values showed that the heart rate did not change significantly in any group. Systolic blood pressure increased (p < 0.05) in SE group, decreased (p < 0.05) in AE and SE groups and did not change in AP and SP groups. Mean blood pressure increased in AE and SE groups, decreased in AP group but did not change significantly in SP group.(ABSTRACT TRUNCATED AT 250 WORDS)

Research for the cure for paralysis caused by spinal cord injury has followed three complementary lines: Limitation of secondary lesions; the use of antagonists of excitatory amino acids has proven affective in reducing the extent of the lesions. Control of the glial scar; an oxygenated derivative of cholesterol can reduce the proliferation of reactive astrocytes and their hypertrophy, and permit the regrowth of axons in a denervated territory. Transplantation of embryonic neurons below the lesion allows to reinnervate denervated sites and reestablish reflex functions.

Some kind of anaesthesia could be able to be used as theoretical models to build both hypothesis about awakening and methods for its study. There are codified anaesthesia for short operations, using few drugs with well known pharmacology. Studying awakening requires circumstantial screens to identify awake marks. Such a screen has been used for some years in this type of anaesthesia given for voluntary pregnancy termination. Similar but not identical marks are observed while the subject drop asleep and awake. They seem approximate marks observed with other screens used for coma awakening survey. But an interpretation of this marks, necessarily cautious, is usable only inside these anaesthetic conditions; if so, psychological explanations appears no more but no less useful than bio-pharmacological one.

Many patients show maladjusted behavior after the wake up period (weeks or months after) and need a psychological care. To recognise the meaning of parts of behavior, to reconstruct this parts as dislocated pieces of a happened but "unlived" personal experience solve the patient's problem. The examples can be discussed in regard of the question raised by this particular experience.

"It's a dream ..." is the frequent definition of Intensive Care and Coma Experience proposed by patients. Does this word, so insistent and often heard in our research and those of many colleagues, correspond to the objective terms (onirism, confusion, delirium) qualifying clinical awakening or coma (as patients do assert it)? Or doesn't it rather point to a specific status of an other psychical experience? That is the author's hypothesis here developed, through specific aspects of awakening state and therapeutical implications.

In our every day practice in intensive care unit, we have the constant worry to join words to our care, is it towards conscious our unconscious patients. This paper is the issue of a work of listening and thinking over from the nursing team, to the testimony of a patient who was in our unit for three months. This person was in the coma for long weeks, and he tells us afterwards about how he experienced this trial.