Anesthesie, analgesie, reanimation最新文献

Sixty patients were studied during non cardiac thoracic surgery. In 21,6 p. cent a culture of organism was isolated and for 53.8 p. cent of them developed a pneumonic process during postoperative period. The organism'role was confirmed by clinical correlation and an abnormal chent radiograph. The same organism was isolated in blood culture sputum or empyema. On the other side the patients with sterile cultures had always a favorable course. The results confirmed the interest of the method which would permit a prophylactic antibiotherapy.

Hemodynamic data of 8 patients undergoing planned resection of abdominal aortic aneurysm are statistically analyzed by variance analysis ("patient" factor and "time" factor). The results are: 1. "Patient" factor exists for all the variables studied. 2. "Time" factor is present for some of them. After aortic clamping, there is a significant decrease of the systolic index (p less than 0.05) and of the left ventricular systolic work index (p less than 0.01). After aorting declamping, a high significant increase of the mean right auricular pressure (p less than 0.001) and of mean capillary wedge pressure (p less than 0.001) are seen. Similar results are observed at the end of surgery. The results are commented with regard of the literature.

Circadian rhythms of cortisol were studied in 10 patients. This study was made shortly after the burn and for a short period of one or two days maximum in 9 patients. Blood level measurements of cortisone were made in 4 patients. 7 patients died. The analysis of circadian rhythm was made with a computer (méthode de régression harmonique combinée à une analyse de variance). The results are deceiving: there are qualitative and quantitative disturbances but we could not give a significance to them, each patient reacting differently. In one case, a drop of cortisol to 0 was observed and the patient died, this observation shows the development of corticosurrenal failure. So, one or several measurements do not allow the study of corticosurrenal function which differs in each case. Theoretical appreciations in handbooks on the subject must be tempered.

One hundred and one patients with terminal cancer suffering severe pains reluctant to other treatment have received morphine by mouth, in a regular regimen. The doses range between 5 and 60 mg every 4 hours. 71 p. cent of our patients have their pain alleviated without any side effect impeding the treatment.

The authors relate their experience of 61 rectal anesthesias with ketamine (10 mg/kg) and diazepam (0.25-0.5 mg/kg). Rectal anesthesia is well accepted by children who are afraid of percutaneous injection. When ketamine is used alone, they obtained only 76 p. cent good result. When diazepam is associated, good results arise to 95 p. cent. Diazepam added to ketamine allows surface surgery during 10 to 15 minutes.

Computerised axial tomography requires total immobility, which must be obtained by a simple and safe technique of anaesthesia. Three anaesthesia techniques were used and analysed in 54 children aged less than 5 years: the technique of the feeding bottle, sedation with pentobarbital or diazepam and general anaesthesia with ketamine hydrochloride. The technique of the feeding bottle can be proposed in selected patients. Sedation can be also used but judiciously, not to deep. The systematic use of an depression immobilizing mattress with these two techniques gives better results. Intramuscular ketamine hydrochloride, when not contrindicate (intracranial hypertension or acute hydrocephaly), has been used always successfully.

In order to determine the rule of neurologic stimuli on the renin-angiotensin system, during surgery, plasma renin activity (PRA) was measured in two groups of patients submitted to either general (group I, N = 7) or epidural (group II, N = 5) anaesthesia during total hip replacement. Salt intakes were normal for all patients before the operation and the perfusion rate, of isotonic saline solution was 5 ml/minute during the surgical procedure. A significant rise in PRA was observed after the skin incision in the first group of patients under general anaesthesia. Epidural anaesthesia suppressed the renin response to surgery. The blockade of conduction along nervous pathways afferent from the surgical area and along renal sympathetic pathways explains the effect of epidural anaesthesia. The lack of increase in PRA despite a significant fall in blood pressure after epidural anaesthesia, also suggests an inhibition of the catecholamines secretion.

This retrospective study shows correlations between the occurrence of pulmonary and massive blood transfusion in 50 seriously injured patients. They received massive transfusions on an average of 13 titers (minimum 51, maximum 30 l) including from 0 to 7,51 of macromolecular solutions (average 2,43 1). These seriously injured patients were divided into 4 groups: --20 thoracic injured patients with associated abdominal lesions, --15 thoracic injured patients without any abdominal lesions, --4 peripheral traumatism with abdominal lesions, --11 polytraumatic patients (considering only lesions of the limbs). There is a significant difference between seriously injured patients with associated abdominal lesions who were transfused and the other groups studied. Sixteen patients experienced pulmonary edema the diagnosis of which was reinforced on grounds of clinical, biological and radiological evidences. Significant difference (p:minor 0,05) were noted as regard the incidence of pulmonary edema when comparing the volume of fluids administrated to the different groups. New out of 16 patients died, mainly because of refractory hypoxia. When more than 25 liters of fluids are transfused, the prognosis is poor. Though pulmonary edema may be brought about by transfusion, other etiologic possibilities are to be investigated.