Anesthesie, analgesie, reanimation最新文献

The effects of intravenously infused succinylcholine (SCh): 1 mg/kg/minute during 30 minutes were assessed in anesthetized dogs on spontaneous heart rate, conduction within the atrio-ventricular node and the His-Purkinje system and on atrial (AERP) and atrio-ventricular (AVERP) effective refractory periods with varying levels of vagal tone and under mild hyperkalemia. 1) The heart rate which was not affected by SCh in the absence of vagal tone was by contrast increased by 50 p. cent when vagal tone was maintained. Under hyperkalemia, the vagolysis-mediated tachycardia did not prove more marked. 2) The conduction velocity, which was never modified by SCh in either the atria or the His-Purkinje system, was always accelerated with vagal tone. This acceleration is directly related to the vagolytic properties of SCh, but also partly to a mild hyperkalemia. The changes of potassium blood levels tend to reverse the potassium outflow due to the parasympathetic neuromediator. 3) The AERP was was lengthened by SCh and hyperkalemia; the latter impaired the outflow of potassium ions responsible for repolarization. The AVERP was always shortened when the vagal tone is maintained, however less largely under mild hyperkalemia which limits SCh anticholinergic effect owing to its own anticholinergic action.

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.

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.

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.

An accidental case of delayed haemolytic reaction due to an anti-D allo-immunization in a patient suffering from multiple traumatic injuries allows us to define a procedure of emergency treatment towards non iso-Rhesus transfusions and the problems posed by the detection of acquired allo-antibodies.

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 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.

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.