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

Morphine at very low dose gives a good post-operatory analgesia without major secondary effects. This study analyses retrospectively 285 spinal anaesthesia with hyperbaric 0.5% bupivacaine 0.2 mg.kg-1 and morphine 0.25 mg in adult urologic surgery. The analysis of enquiry in analgesic during the post-operatory period shows that in most cases (72%) the patients have supported the first 24 hours without any complementary analgesia; 28% of patients needs a complementary analgesia realized with 1 g of paracetamol. Intravenous morphinics have never been necessary in post-operative period. The analgesia was adequate for the patient's comfort, and it never mask a surgery complication. No respiratory complication appeared, even in 13 patients who needed intravenous morphinics in per-operative.

The aim of the study was to evaluate the relationship between germs found in samples systematically taken in the organ donors and germs found in the corresponding recipients in the 8 post-operative days. The 100 brain-dead patients received oxacillin (2g every 4 hours) when the bacteriological samples were taken. 41% of the donors were germ carriers. The germs were mainly located in the respiratory track (Staphylococcus aureus meti-S (34%) and Hemophilus (29%)). Among the 86 patients harvested, 40 donors were germ carriers and gave 132 organs, 46 donors were not germ carrier and gave 151 organs. The comparison between these two groups showed no difference. Assessment of infection occurring in organ recipient in the 8 post-operative days (germ, location, evolution) showed no difference, whether organs were removed from germ carrier donors or no. Comparison between the germs found in germ carrier donors and those found in recipients with sepsis showed a similitude in three cases (2.2%). In the other cases, there is no relationship between the germs found in the donors and post-operative sepsis in the recipient.

41 french clinical hematologic departments were questioned about their oral feeding practice for compromised patients. In conclusion, an agreement seems necessary to define the goals of the hematological patients' feeding, to set going the measures and to assess the food proceeding treatments.

A man 55 years old reached of chronic bronchopneumopathy was underwent a subumbilical surgery under an epidural anesthesia. The puncture has been realized at the level of the space L3-L4, with the location of an epidural catheter after negative aspiration test. The local anesthetic with lidocaine 2% (12 ml) Ten minutes later, the patient presented cardiac arrest that evaluated favourably under the cardiocirculatory intensive care. Blood and LCR analysis exclude the eventuality of a toxic accident, an anaphylaxia or spinal anesthesia.

In order to estimate the preoperative evaluation of the respiratory risk, a well adapted clinical examination associated with a routine pulmonary function test (VC, FEV1) can be sufficient. Although some patients with cardiopulmonary disorders or candidates to lung resection need more complex assessments: the flow-volume loop to detect small airways obstruction (MEF 50%, MEF 25%), measure of bronchial hyperreactivity to predict bronchospasm during anaesthesia, residual volume for the diagnosis of emphysema, diffusing capacity (DCO) to discover lung fibrosis: these parameters disruption always make the pronostic worse. It is also useful to couple together preoperative function test and pulmonary scintigraphy to predict post-operative values after lung resection. But, these criteria for operability are not always a good indicator of post-operative complications. So it is possible to use in addition the results of exercise testing to determine cardio-respiratory performances and maximal oxygen consumption (VO2MAX) which seem better correlated with mortality and post-operative lung surgical complications. Preliminary results of our study concerning thirty patients hospitalized in Besancon-St-Jacques Hospital, agree with the hypothesis that exercise testing is an important criterion in the pre-operative evaluation and to predict post-operative mortality and morbidity of patients candidates to thoracic surgery.

The interest and the limits of different hemodynamic parameters are recalled: measure of right arterial pressure and pulmonary artery pressure, continuous measurement of SvO2. Technological and theoretical knowledge are necessary to interpret the results.

Criteria of quality of gases and vapours supply, ventilator, patient's circle circuit and monitoring devices are recalled to help the anesthetist to choose his anesthesia machine. Advantages of compact or modular apparatus are discussed. Four, now wellknown, anesthesia machines (modulus II+, Siemens 900 D+SAC985, Roche Kontron 4300 and Engstrom Elsa) were analysed in clinical controlled ventilation and in simulated spontaneous ventilation to study the imposed work of breathing. Results are discussed with regard to safety rules and to ergonomics, bearing in mind their respective prices. Comparison is made with an original "bisontin" prototype.

During aorto-biiliac by-pass, patients with heart disease are exposed at many haemodynamic problems. Mixed venous oxygen saturation monitoring help anesthetist along clamping and unclamping periods. This study concerning 13 patients with pre-operative NYHA class II and III congestive heart disease, discusses therapeutic algorithm especially for choosing inotropic or vasodilatator drugs.

From a concrete example, the authors remind the interest to envisage the possibilities of sterilization as early as the initial period of a research about biomaterials. Indeed certain kinds of sterilization may be too much aggressive for biomaterials, especially the polymers, whom the structure is so impaired. These biomaterials may become ineffective even dangerous and blight a long time of research. The authors also expose the necessity to respect the good manufacturing practices of laboratory and the rules of hospital hygienics which is indispensable for all the members of the teams which participate to biomedical or clinical researches. A condition for the respect of these rules is the utilization of a common and well understood language between the medical and no medical teams.