Anesthesie, analgesie, reanimation最新文献

Using a spectrometer for the study of exhaled gases and a monitor of transcutaneous oxygen pressure, our purpose has been to quantify our ideas about physiological apneas in the conscious voluntary adults. We compared the apneas, concerning the duration and the induced fall of peripheric oxygen pressure, after normoventilations in air and in oxygen, then after hyperventilations in air and in oxygen. These experiences confirm the tiny interest of previous normoventilation in oxygen compared with in air, the danger of hypoxemia by previous hyperventilation in air and the possibility of prolonged but safe apnea after hyperventilations in oxygen, that we can advocate in the induction of anaesthesia for some circumstances.

The external cardiac massage mechanism is commonly related to the ventricles compression between the vertebral block and the sternum. This over-simple explanation must be reconsidered. Following recent data, the intra thoracic pressure changes take probably a major part in it efficiency. Six patients have been studied by hemodynamic intra aortic measurements and Doppler carotidian velocimetry. Intra thoracic pressure have been recorded by an oesophageal catheter. Results are in agreement with the prominent part of the intra thoracic pressure variations. Various external cardiac methods are investigated following this monitoring. Some aspects of the classical management of the cardiac arrest have to be discussed.

The authors test the effectiveness of ornidazole in digestive surgery and surgical reanimation. They emphasize the increased frequency of anaerobic bacteria and the role of beta-lactamine and aminoside antibiotics in the selection of these pathogens. Ornidazole was used for a one year period as either a curative or prophylactic treatment. The product is very well tolerated. During the year the authors noted a decreased frequency of bacteroides bacteremia. They highly recommend the association of penicillin G in traumatology to fight gram negative anaerobic bacilli and numerous gram positive bacteria. The association with gentamycin is justified in the presence of an anaerobic gram negative digestive flora. The use of third generation antibiotics has often proved to be futile. It is recommended that they be reserved for the most resistant organisms seen in primary extra-hospital infections. The prescription of ornidazole must procede and follow the surgical eradication of focal intra-abdominal infections, especially if it is an infection of appendicular origine.

Efficiency of cimetidine in therapy and prevention of stress ulcer has been tested in a double blind study with endoscopic examination at the time of inclusion and a week later. This study concerns forty patients with severe cerebral disorders and prolonged coma. In preventive group (20 subjects) we noticed 55 p. cent of success under placebo and 37 p. cent with cimetidine. In therapy group (20 subjects) cimetidine was not different from placebo (37,5 of success v. s. 41,25 p. cent). Two patients presented hematemesis. The relative failure of cimetidine in these patients is discussed and some explanations are envisaged.

Twenty five healthy pregnant women received an epidural injection (at levels varying from T11-T12 to L3-L4) of morphine (2 or 3 mg in 10 ml of saline solution 9 p. thousand) in order to achieve pain relief for delivery. The degree of dilation never exceeded 5 cm at time of injection. Pain level decreased in 22 cases (88 p. cent) but only 16 women (64 p. cent) were fully satisfied. Hypoalgesia begun after 25 minutes and disappeared after 19 hours. No respiratory or haemodynamic changes were noted. On the other hand, the duration of the first stage of labour decreased. The best results are seen when injection is achieved at highest levels, facing spinal cord segments supplying the cervix and the perineum. No newborn showed any sign of respiratory or neurologic depression.

The authors encountered technical difficulties for the endotracheal intubation but neither laryngeal damage nor serious oropharyngeal lesions occurred after this intubation. The general evolution was favourable without specific trouble (cutaneous or infectious). The risk of intubation was reexamined from the recent literature. It is generally believed that there is a tendency for the skin to become more resistant to the formation of bullae as the afflicted children grow older. So, when another disease sets vital prognosis in action, major surgical operations can be performed and more especially as the average length of life is now increasing for these patients.

The authors report on a retrospective study of 30 severe acute pancreatitis. The severity of the illness is documented by operative statement and evolution of the disease = 50 p. cent of mortality. A first group of 10 patients (1972-1975) was treated by primary intensive care and rapid ablative surgery with 10 deaths. A second group of 20 patients (1976-1980) was treated by primary intensive care, artificial nutrition and secondary surgical drainage. Mortality is significantly lower in the second group (5 deaths). It is concluded that all severe acute pancreatitis should be initially managed by intensive metabolic care and respiratory support if necessary. The only indication for primary surgery is a diagnostic doubt with peritonitis or bowell infarction. The authors emphasize the improvement of the prognosis of severe acute pancreatitis related to hemodynamic and respiratory measures and to a better nutritionnal support. Surgery should be secondary on a well prepared patient. Drainage or sequestrectomy support a lower mortality than ablative surgery.

Cytomegalovirus infections are transmitted among adults by transfusion of fresh blood. This benign infection is characterised by a single febrile syndrome that appears, on an average, 22 days after the transfusion and may last as long as 6 weeks. Hematological anomalies are significant: inversion of the leucocytic formula with high rate of mononucleosis, founded on the presence of hyperbasophilic mononuclear cells that appears about the 30th day, will be confirmed when the virus is isolated in mononuclear cells and in urine and by means of situation fo C. M. V. antibodies. Those post-transfusion C. M. V. infections are frequent after extra-corporeal circulation but only appear clinically in 1 p. cent of cases.