Annales de l'anesthesiologie francaise最新文献

The search in man for experimental techniques suitable for study of the neurospecificity of anaesthetic drugs led us to use the blink reflex. Thirteen female volunteers undergoing gynaecological surgery received as a double-blind basis either 0.2 mg/kg of diazepam (7 cases) or 3 X 10(-1) mg/kg of fentanyl (6 cases) intravenously. The thresholds of the two components of the reflex R1 + R2, of respectively tactile and painful natures, were sought before and for three minutes after the injection of the drugs. The threshold of R2 rose to four times its initial value (P less than 0.001) after diazepam, whilst R1 remained unchanged. Fentanyl was not associated with any change in the thresholds. Study of the blink reflex may be used to dissociate and analyse the effects of two drugs on precise nervous functions. The nature of these functions and of their controls are discussed.

Treatment of burns patients in the Lomé Teaching Hospital Centre has been reviewed and adapted to local conditions. The present study concerned 108 burned children, treated over a two year period. Burns in children are frequent. Boys are affected more frequently: 66.6 p. 100. Accidents are, above all, domestic and occur during the cooking of meals, at an age of 3 to 4 years (66.4 p. 100). Only thermal burns are seen, boiling fluids being involved in 71.3 p. 100 of cases. Superficial burns are the most common: 63.9 p 100, and intermediate 21.3 p. 100. Treatment is based upon water and electrolyte replacement and exposure to air. Infectious complications are the most frequent. Mortality involves 6.4 p. 100 of cases. All of these children were more than 35 p. 100 burnt. The cause of death is often infection. Results show 72.5 p. 100 of cases of cure without sequelae, 18.2 p. 100 of anesthetic sequelae and 9.3 p 100 of functional sequelae. If it were needed, these sequelae emphasize the fact that prevention remains and will remain the best form of treatment of burns.

The authors describe a method for haemodynamic and respiratory surveillance which they applied to 45 severely ill patients in circulatory and/or respiratory distress. Only an arterial and central venous catheter are necessary. They are used to measure arterial and venous blood gas levels as well as cardiac output by dye dilution. Long term surveillance is made possible by the absence of a Swan-Ganz catheter. Periods were as 7 to 35 days with a mean of 12.6 days, during which 910 assessments were made with the use of 64 arterial catheters and 71 venous catheters. The method reduces the prevalence of itrogenic accidents complicating the course of these severely ill patients and considerably lowers the cost of such surveillance. No specifically related complications were seen, problems being limited to the usual percentage of complications due to arterial and venous catheters.

Most drugs given to pregnant women at the end of pregnancy and during delivery cross the placenta and can therefore be the cause of disorders in the neonate. A study of neonatal pharmacokinetics of drugs administered to women during delivery, correlated with a study of fetal physiology and the neurosensorial behavior of the neonate should allow us to better understand certain disorders of neonatal adaptations to extra-uterine life.

Postoperative infection in routine digestive surgery is a common complication, its prevalence being variously assessed between 10 and 30%. Study of criteria of infectious risk, whether inherent to the subject or his environment, has not been the subject of overall evaluation. The present study involved 308 subjects in two departments of surgery with different geographical and architectural features. A comparison was first made between the two departments in terms of the surgical population and the reaction rate. The presence was then sought of a relationship between infection, whether general or local (urinary tract, pulmonary, septicaemia) and factors concerning the bacteriological environment and factors indicative of the resistance of the subject. The statistical technique of discriminant analysis was used to determine the preponderance of certain factors which might be indicative of at risk subjects.