Anesthesie, analgesie, reanimation最新文献

Immunological safety in blood transfusion necessitates good organization, on one hand in the department responsible for the reception of the patient, and on the other hand, in the immunohematological laboratory. Perfect cooperation between the clinicians and the biologists is indispensable. Four tests are essential to ensure the biological surveillance of blood transfusions: ABO and Rhesus (D) typing, screening of irregular agglutinins, the compatibility test and the final check at the patient's bed side. Justified indications for each examination and their perfect technical realization are the two conditions necessary for the success of blood transfusions, it is still very frequent to see these precise rules neglected.

The authors have performed 66 (cranial or spinal) operations with electro-anaesthesia supplemented by neuroleptics and pancuronium. In this technique, which respects the necessities of neurosurgical anaesthesia, analgesia is produced by means of Limoge's rectified high frequency currents. The protocol consists of: induction by a neuroleptic, application of the electrical current, intubation with benzodiazepin and succicurarium, controlled ventilation with a 50 p. cent oxygen/50 p. cent nitrous oxyd mixture and curare as required. The efficiency was estimated according to the necessity of a supplementary drug analgesia (fentanyl). The use of fentanyl, i.e. drug intoxication, was strongly reduced in 90 p. cent of the cases (average 0,46 micrograms/kg/hour). Absolute failures were encountered in 3 cases only. Patients waked up in very good conditions and extubation occurred on an average of 16 minutes. Reflexes of cough an deglutition are not depressed by electro-anaesthesia and we think this preservation of the respiratory function to be very profitable for such neurosurgical patients. Our opinion by now is that the best indications for electro-anaesthesia are high-risk patients, with a special mention for surgery of the posterior fossa.

Seventy transtracheal aspirates (T.T.A.) have been achieved with patients having an acute pneumonia; 42 had a chronic respiratory failure; 25 had received a previous antibiotherapy; 49 presented negatives delayed hypersensitivity skin reactions. No major accident was noticed and the T.T.A. were positive in 87 p. cent of the cases. The results show the predominance of the Cocci Gram + especially pneumococcus. These cases are associated with Hemophilus influenzae in 19 p. cent of the cases. Negative skin tests show the frequency of this association. Infections with Bacilles Gram -- are found as well in this circumstance. The previous antibiotherapy alters microflora and leads to a B.G. -- as well predominance. At last, the evolution is not influenced by the discovery of an organism in the T.T.A. The authors compare the results with those found in previous work and conclude in the interest of that method which enable a quick identification of the organism and the starting of a well adapted antibiotherapy.

One of these two cases (1 h 30 and 48 hours) was permanent. The cause of the paralysis seems to be either from compression of the nerve between the endotracheal tube cuff and the cricoid, or from compression between the thyroid ala and a dislocated arytenoid cartilage from use of an unnecessarily large tube. An anatomical study has helped to confirm this hypothesis and shows the presence of an ischaemic aera overlying the nerve at the level of its entrance into the larynx due to the endotracheal cuff.

A case of unilateral lung disease, treated by independent unsynchronized ventilation of each lung, with a selective end expiratory pressure is reported. The better effects of this method seem to be the improvement of respiratory mechanics and gas exchange and the decrease of the intrapulmonary shunt.

According to Powers et collaborators the hypothesis that intramyocardial vessels may be collapsed in artificially ventilated patient with added PEEP, could be arisen. So, myocardial ischemia may explain why in some of those ones there appear signs of left ventricular failure. To test whether this reasoning was correct we measured LVEDP in normal dogs submitted to increasing levels of PEEP up to 40 cm H2O. Our results seem to point towards the following conclusions: a) In normal dogs, Starling relation is not altered and remains within the same hypercontractility pattern. b) As PEEP increases, ventricular function remains within the same curve up to 30 cm H2O and jumps to a higher contractility curve at 40 cm H2O of PEEP. All of this would suggest that under our experimental conditions it does not seem reasonable to assume the existence of left ventricular failure due to PEEP influence.

Unlabelled: Aim of investigations: Very often, chronic pain treatments used for the management of terminal ill cancer patients do not prevent acute or incident pain from coming up. For twenty months D-phenylalanine (DPA), an enkephalinase inhibitor, has been investigated in order to forestall this pain.

Methods: Nine caucasian patients, three males and six females, between forty-nine and seventy-eight, were selected for this trial after informed consent. They were all undergoing severe incident pains related to complications (scabies, osteoporosis, painful cough or colic, Charley-Horse, RX-necrosis of skin or mucous membranes, etc) in spite of having their chronic pain component cured: phanol-rhizotomy: two cases, neuro-adrenolysis by alcohol: four cases, Brampton mixture: three cases. They were administered DPA, 250 mg three times a day for fifteen days, followed by a ten days pause, resumption and so on.

Results: Seven patients out of nine were alleviated and they never claimed for more or other analgesics until they died. Four of them got very good ataraxia during the same time (survival mean x = 99,33 days). No side effect was reported, even in patients taking Brampton mixture.

Conclusions: DPA seems a useful drug to prevent acute or incident pain in malignant diseases. Our data point out the consequences the enkephalinases inhibitors will take up for the cure of intractable cancer pain.