Anesthesie, analgesie, reanimation最新文献

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.

The hemodynamic effects of a single dose of fentanyl (4 micrograms/kg) and of thiopental (5 mg/kg) were studied on cranial trauma patients who have hypertension and who are ventilated at constant volume and frequency. At first the results were collected without an hypertensive treatment, in the second time the same results were collected after the injection of an anti-hypertensive drug (guanoxabenz 70 micrograms/kg). The results showed that in two series the modification in the measured parameters was not statistically significant; the used drugs produced little change in the hemodynamic profile: a) Even with insignificant, we noted that the injection of fentanyl after an anti-hypertensive drug caused a smaller change in the blood pressure and cardiac index then was seen in untreated subjects. b) With thiopental treated subjects, the arterial pressure is not decreased because of the increased systemic resistances, at the same time changes in cardiac index are essentially identical whether or not the subject was treated with guanoxabenz. The results therefore tend to show that the anti-hypertensive treatment can be continued without any interruption by a surgical operation.

This work analyzes the results of 88 blocks for intractable pain in thoracic and abdominal malignant diseases. Results and duration of analgesia are compared in regard to the localization of pain and to the use of alcohol or phenol. Best analgesic results are obtained in the pelvic pains and especially in the colorectal pains. The analgesic results and the duration of analgesia are poorer since the spinal nerves to block are higher, there are only 50 p. cent of good results in the thoracic region. Analgesic results are the same with alcohol or phenol, but duration of analgesia seems to be longer with phenol. The two routes of administration, subarachnoid or epidural, seem to give equal results. Motor paralysis of the bladder or the rectum may occur, especially in the low pelvic localizations and these complications justify careful selection of the indication.

The authors give their experiences in nurseling and children brain neuroradiology anaesthesia. Sodium gammahydroxybutyrate has been definitively adopted after multiples anaesthesial protocoles for the gaz tomoencephalographic exam, known for its technical risks. The gamma OH gives a perfect cardiac and pulmonary stability in difficult conditions, with normal intracranial pression, even in children anaesthesia with Halothane (0.5%) for complementary analgesic effect or with fractionate injections of dextromoramide. Pneumoencephalography has been releguated in second place by the even of brain computer tomography except some particular indications. But this exam qualified as painless is usually indicated in fragile and deficient childrens. Though the intravenous iodated contrasted substance injection can improve the scan image quality and may induce secondary effects at 2 cm3/kg dose. It's again gamma OH after correct premedication that gives stable, perfect immobility, cardiac and pulmonary stability in an ideal anaesthesia for non ventilated patients. The only critical aspect of this method consists on a prolonged and imprevisible delay to awake so that it cannot be an ambulatory anaesthesial method. Therefore it appears that gamma OH in spite of brain computer tomographic event, is an interesting anaesthesic drug but non definitive in brain neuroradiological exam for childrens.

The aim of the present investigation was to study the possible means to prevent the subclavian vein catheter related infections. The tip of the catheter and the part situating at the skin puncture were cultured using the semiquantitative culture method. The growth of the micro-organisms was divided into three groups: classical pathogenic, opportunistic and non pathogenic. We did not find any growth in 64 p. cent of the catheters. The puncture site gave growth in 15 p. cent, the catheter tip in 6,5 p. cent and both of them in 14 p. cent In this study four cases (1,5 p. cent) of septicemias were found. In these cases Streptococcus fecalis was the most common microorganism. The aim of the semiquantitative culture method was to differentiate a real catheter related infection and contamination. The real infection was found only in 32 catheter tips though growth was seen in 54 catheter tips. According to this investigation it seems that the most important factor in preventing catheter related infections was strict sterility during the catheter placement as well as during the maintenance. A small dose of heparin probably reduces the formation of fibrin sleeve around the catheter tip and thus prevents infections. The time the patient is catheterized is also of importance, patients with catheter related septicemia had twice as long duration than cases without growth of catheter tip.

The authors describe an anesthetic technique used for endoscopies (laryngo-tracheo-bronchoscopies) in 100 children under five years age. Three different apparatus for jet ventilation are used: manual injection, automatic injection and high frequency positive pressure ventilation. The first apparatus is home made. It allows control of insufflation of O2 by manual compression of a gun type injector. With the second one (Wolf injectomat), injection of O2 or O2/N2O is automatic. The aga bronchovent is used for high frequency positive ventilation with O2.

Complications of loco-regional anaesthesia in obstetrics are usually due to several factors: 1. choice of drugs: this must be judicious, taking into account duration of effect, potency and eventual maternal and foetal toxicity. This rule includes also morphinic drugs; 2. choice of technique: taking into consideration the stage of labour and also the eventual surgical procedure. Paracervical block must be avoided because of the numerous side-effects, chiefly foetal distress. Spinal anaesthesia is indicated only for instrumental procedures or caesarian section, with the usual reserves about headaches, severe hypotension. Peridural anaesthesia may present some complications, like extensive peridural anaesthesia, hypotension. In eclampsia and gemellarity, loco-regional, anaesthesia must be induced with the utmost caution. Moreover, an unrecognized uterine rupture may happen during labour under medullary anaesthesia if the patient had previously a caesarian section.

The authors describe two post-operative Adult Respiratory Distress Syndrome (A. R. D. S.) due to Mycoplasma pneumoniae. Mycoplasma pneumoniae infection is attested by serologic arguments and isolement of Eaton Agent in throat cultures. In the first case, exists an activation of the altern way of complement. The unusual relations between Mycoplasma infection and the A. R. D. S., diagnostic and therapeutic are commented.

Hemodynamic effects of nicergoline injected by intravenous route were studied in 43 patients early after open-heart operations. A serial witnesses has been compared with 5 other groups for which the posologies were increased. Catheterisms of radial artery and pulmonary artery allows the measuring of systolic arterial pressure (SP), right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP) and cardiac index (CI). The heart rate (HR) was noticed. The systemic vascular resistance (SVR), the stroke index (SI) and the left ventricular stroke work index (SWI) were calculated. The results were statistically analysed by the Student test. After injection of a bolus of 0,3 mg kg-1 by intravenous route, stable effects are obtained with a maintenance posology of 0,8 mg.kg-1.h-1. The SP diminishes by 20 p. cent (123 to 104 mm Hg; p less than 0,01). There is a loose of 16 p. cent from the RAP (9,5 to 8 mm Hg; p less than 0,05) and of 18 p. cent from the PCWP (16,5 to 13,5 mm Hg; NS). The HR decreases by 13 p. cent (97 to 81 syst. min.-1; p less than 0,05). The CI increases by 25 p. cent (2,2 to 2,75 1.min.-1m-2; p less than 0,01); the SI by 40 p. cent (35 to 35 ml beat-1m-2; p less than 0,01) and the SWI by 32 p. cent (27,5 to 36 g.m.m-2; p less than 0,05). We conclude from this investigation that nicergoline injected through intravenous route with an output of 0,8 mg.kg-1.h-1 mainly leads to afterload reduction. Thanks to its effect on the CI and on the HR as well as to its mild to moderate action, it is a clinical useful agent for primary or adjunctive therapy of postoperative low cardiac output.

This infusion used instead of whole blood has become increasingly common. However in our, as in other french institutions, the volume and the hematocrit of blood contained in each unit varies often notably. In addition, because of their high viscosity packed erythrocytes cannot be transfused rapidly enough. For transfusion in emergency situations and transfusion in operating room, following suggestions could be made to blood banks: --each unit should provide information on its content (volume and hematocrit or hemoglobin content); --units with low blood content should be transfused outside the operating room, whereas units containing high volumes should be reserved for peroperative transfusion in order to reduce charge of manipulation; --packed erythrocytes units should be prepared in order to allow same transfusion rates as whole blood (i.e. an average of 100 ml per minute for one transfusion line); --packed erythrocytes units should contain about 80 ml of plasma for an average total concentrate volume of 260 ml in order to provide enough antibacterial defense components; --units of fresh whole blood should be provided when approximately 150 p. cent of recipient's blood volume has been replaced in order to maintain the critical platelet level.