Anesthesie, analgesie, reanimation最新文献

The authors use the Bain Circuit with spontaneous breathing during head surgery (neurosurgery and ophthalmological procedures). Suitable for both adult and pediatric use, it seems to be, due to its unique characteristics, the choice circuit for all anaesthesia procedures in which the physician does not have direct control over the patient's head. Comparative analysis of blood gas levels is effected, on the one hand in children connected to a Digby-Leigh system and Bain Circuit, and on the other hand in adults, some of whom are connected to a two-way system and the other under a filter circuit; all of the patients are then connected to the Bain Circuit. In children the analysis of results shows that for an identical protocol of anaesthesia the quality of spontaneous breathing obtained using the Bain Circuit is the same as that obtained using the Digby-Leigh. In adults anaesthetized using fluothane and with spontaneous breathing, the average level of hypercapnia under filter circuit and Bain Circuit is identical. Also, the same level of alveolar hypoventilation is obtained under spontaneous breathing with the two-way and Bain Circuit systems when there are properly provisioned. Thus this work confirms other studies by showing that the Bain Circuit is particularly well adapted to head surgery because of its low weight and easy manageability. On the other hand, when using spontaneous breathing the level of alveolar hypoventilation, and thus the degree of hypercapnia, is directly related to the level of anaesthesia and independent of the circuit chosen. Only the setting up of controlled breathing would allow the physician to work under the desired level of normo or hypocapnia.

The patient who was operated on for the recurrence of a colic cancer had an unknown pituitary adenoma. The adenoma was destructing partly the anterior basis of the skull and was protruding in the nasal fossae. The naso-gastric tube entered without any difficulty the right cerebral hemisphere creating lethal cerebral lesions. Some reflexions determined by this very rare condition are discussed.

A pump is used to reinsert the expiratory gas of a Bain Spoerel system into the circuit. It delivers a 14 l.min-1 flow. The expiratory gas is drawn across a CO2 absorber and fresh gas flow is reduced to the patient's VO2. The technic cumulates the advantages of the closed system to the Bain Spoerel system: practical design for head surgery, no valve, then less energetic loss by the patient in spontaneous ventilation, convenient gas flow, adapted to the small child, because of small dead space, economy of drugs, ecology: no more pollution ! humidification and warming of inspired gas. A hundred patients have been so anaesthetized in head surgery without any problem.

A personal experience with 138 percutaneous cordotomies is presented. The results and complications are compared to those of 49 open cordotomies at C1-C2 level. It is concluded that the percutaneous technique has better results and less complications. Nevertheless the percutaneous cordotomy is sometimes hazardous and presents some inconvenience. For this reason the author prefers in certain cases open cordotomy in a modified microsurgical technique which is described. It is outlined that in the authors opinion cordotomy should be restricted to cancer pain.

Ventilation perfusion inequality, is analysed with the help of a program written in Basic language, easily implemented on a personal computer. For a gas exchange unit, the main equation describes a mass balance for oxygen, assuming absence of diffusion barrier. The use of a large number of these units allows for calculation of the resulting arterial PO2 in case of abnormal ventilation blood flow distribution. Several simulations are made to study the effect of local variations of VA/Q ratio, and oxygen inhalation upon arterial PO2.