Anesthesie, analgesie, reanimation最新文献

Epidural opiate application was performed in 75 patients with chronic pain due to abdominal cancer. To reduce the risk of local infection, the epidural catheter was in part placed subcutaneously. Degree and duration of analgesia were determined after epidural morphine (with and without bupivacaine), pethidine or fentanyl. Hemodynamic and respiratory parameters were measured and side-effects were registered. The longest duration of analgesia was observed after epidural morphine. In long-term treatment there was a reduced efficiency and the frequency of daily injections increased, especially in those patients who already had received systemic opiates prior to the epidural opiate administration. This may be due to tolerance of the spinal receptors. A combination of epidural morphine with small doses of local anesthetics caused prolonged action and delayed the onset of tolerance. Besides slight influences on respiratory function, which may be referred to the initial period of systemic absorption, there were no relevant side-effects. Regarding certain precautions the epidural application of morphine may have advantages in comparison to systemic analgetics in treatment of chronic pain.

One of these shocks occurred in course of a rapid infusion in a patient in whom catheters were previously inserted. So, an hemodynamic study was possible. This study shows a peripheral vasodilatation leading to a decrease of preload and cardiac output, and finally to a systemic hypotension which generally raises the alarm. These cases are the first anaphylactoid shocks reported after an infusion of modified gelatin. They demonstrate the general risk of anaphylactoid shock with all types of colloids.

We gave special attention to these very fragile newborns in whom associated pathology was often present. We were faced above all by respiratory and hemodynamic problems. Pre-operative care is essential and must be adapted to the degree of emergency. The newborn must reach the operating room in normothermia, normoxia and in adequate metabolic status. The anaesthesia technique used was always simple with few anaesthesics and ventilation controlled manually and mechanically after intubation. Scrupulous monitoring was always the case. Principal anaesthesic incidents included hypothermia and tachycardia. A precise cause was linked to the 13 accidents encountered. In 8 cases slow decurarisation was noted. Special comments must be made about the premature infant's possibilities versus pharmacocinetic of anesthesics, hemodynamic modification, hyperbi lirubinemia hepatic and renal enzymatic immaturity. Thus we think the anesthesiologist must be specifically trained for the care of these patients.

For the purposes of this study, sulfentanil is administered to conscious men in increasing doses (0,00015, 0,0003, 0,0006 mg/kg) by intra-muscular injection, and the results are compared with those obtained in the same condition by administration of morphine (0,100, 0,150, 0,200 mg/kg). The administration of both drugs provokes the same side-effects. The failure of the breathing rate is as fast as observed following the administration of morphine in equi-analgesic doses. As in the case of analgesia, the time taken for the falling off of the breathing rate to occur, and its duration are shorter with sulfentanil, than with morphine. In any case their persistence is too great for one, to be able to consider sulfentanil as a drug of very short-term effect. The effects of sulfentanil on the cardiac rhythm (bradycardia) and on arterial pressure (low blood pressure) are slightly less intense, but above all, much shorter than that of a equi-analgesic dose of morphine. The other side-effects which are clinically discernable, particularly those felt by the patient, vomiting and changes in behaviour patterns are minimal; certainly lesser after administration of S than after tha of M. The sedative value are the same and often identical after administration of both drugs. Finally, the euphoric effect of sulfentanil appears to be slighter than that of morphine.

The technic of intermittent mandatory ventilation assures automatically a fraction of ventilatory cycles on a patient who has a spontaneous ventilation. This mechanism used in medical and surgical resuscitation, on twenty one patients of different age-group, has allowed the objectivation of the following elements: - the clinical and the analysis of gaz results are found to be satisfactory at the end of the first hour; - one the contrary from then on, the results tend to differ on the basis of the periods of misadaptation which are more or less long and frequent. Looking after such a ventilatory devise demands as much intensing attention as that of any other artificial ventilation.