Anesthesie, analgesie, reanimation最新文献

Low dose morphine epidurals (0.5 to 4 mg) provide a good way of controlling either per or postoperative pain (210 cases) or chronic, somatic, intractable pain (282 cases). Selective and metameric medullar hypoalgesia is induced at a level which varies with the level of injection. There is an acquired tolerance which restricts the use of such injections to the short-term monitoring of somatic pain. In other types of psychogenic and deafferentiation pain, there is little or no sedation, but there are maximum secondary dysphoric effects. The degree of combination of these dysphoric effects with hypoalgesia is of diagnostic interest of the type of pain involved, and of prognostic interest when both somatic and deafferentation pains are present.

The authors report their experience with 35 guanethidine intravenous local injections in algodystrophic and neurotrophic syndromes. Although excellent results are obtained in post-traumatic algodystrophies which are treated early, they are less remarkable in long standing sequelae due to injuries of the nervous system, and where, at best, only an antalgic effect can be expected.

Sixty-four women undergoing non-abdominal operations were anaesthetized with ketamine administered as a continuous intravenous drip combined or not with diazepam. This double-blind, randomised study assessed the effects of diazepam on the dosage, the cardio-vascular stimulation, and the psychotomimetic side-effects of ketamine. At the induction, ketamine was given in a dose of 2 mg/kg in combination with diazepam 10 mg or placebo i.v. followed by a continuous infusion of ketamine at variable rate. The amounts of ketamine necessary for anaesthesia was significantly reduced by diazepam, from 4.51 mg/kg to 3.55 mg/kg (p less than 0.001). The sympathomimetic effect of ketamine was significantly decreased by diazepam, as the increase in pulse rate as well as in blood pressure was less important (p less than 0.05). The frequency of hallucinations dropped from 30.0 p. cent to 2.9 p. cent with diazepam, while the total frequency of psychotomimetic side-effects fell from 36.6 p. cent to 11.8 p. cent (p less than 0.05). Although the frequency of psychotomimetic side-effects is still high with this method, it may be recommended to use a continuous drip of ketamine administration for anaesthesia of hypovolaemic and other poor risk patients.

Deliberately lowering blood pressure facilitates middle ear surgery. However, bleeding can persist in spite of hypotension in some tachypneic patients. Fentanyl is a powerful morphinomimetic which decreases ventilatory frequency. This work studies the respiratory effects of fentanyl during spontaneous ventilation in 16 anesthetized patients. Their systemic blood pressure was decreased 40 per cent by trimetaphan. One single injection of fentanyl (0.0125 mg) reduced minute ventilation by 26 per cent, mean inspiratory flow rate (VT/T1) and T1/TTOT, but did not modify the pulmonary dynamic compliance. The acid-base balance parameters changed little toward respiratory alkalosis by trimetaphan and returned to their control values after the injection of fentanyl. Thus, a small dose of fentanyl can be combined with controlled hypotension during anesthesia and spontaneous ventilation without respiratory risk or an acid-base inbalance. With this dose, it has an efficient central influence to reduce the breathing frequency and can be used to lessen bleeding.

Immunological safety of red blood cell transfusions implies both prevention of hemolytic reactions and prevention of red cell alloimmunization. A review of clinical, etiologic and immunohematological aspects of hemolytic hazards of blood transfusion is presented and the main conclusions regarding their prevention are emphasized. Appropriate measures to prevent red cell alloimmunization are outlined in the light of known variables which contribute to alloantibody formation. Prophylactic measures are suggested to be focused on the one hand on the most immunogenic red cell antigens, c, E, K. and on the other hand on the high risk individuals, young women and multitransfused patients.

Unlabelled: To specify pharmacological interferences between droperidol and fentanyl an experimental study was carried out on mice. The analgesic kinetic was studied after the administration of the two drugs in a concentration ratio between 25/1 and 150/1.

Results: Fentanyl is a potent analgesic with a short time effect. It has very good correlations between dose effect and time effect. Droperidol does not have a analgesic effect. The behaviour of the two drugs depends on the way they are administered, either simultaneously or consecutively: simultaneous administration of the two drugs increases the level and duration of analgesia: nalaxone reverses analgesia, a fentanyl injection given 5 minutes before a droperidol injection produces the same analgesia as fentanyl alone, a droperidol injection given 5 minutes before a fentanyl injection induces a level of analgesia lower than fentanyl alone. Droperidol appears to reverse the fentanyl analgesia.

Haemodynamic function was assessed in twenty patients with severe pre-eclampsia or eclampsia. In front of the earlier well-known data hypercinetic circulatory status was found with vascular resistance almost unchanged. As some investigators found two levels placental blood flow, haemodynamic status may be different in some cases. Consequences on therapy are discussed especially beta-bloquers and potential deleterious effects of anti-hypertensive treatments.

The authors relate their experience of 61 inhalation anesthesia of children from 5 months to 15 years years old. Head-tent is usually employed for intensive care as a method to administrate pure oxygen. Children are often afraid of the face-mask and tolerate head-tent easier. Three different protocols were studied: Nitrous oxide and oxygen mixture at different level (50 p. cent oxygen, 50 p. cent nitrous-oxide; or 30 p. cent oxygen, 70 p. cent nitrous oxide). The authors also used halothan in the inhalated mixture. The rebreathing level of CO2 in the head-tent according to the gas flow was measured. No incident, nor accident are related. This new anesthetic apparatus is easy to use, well accepted by children.