Annales de l'anesthesiologie francaise最新文献

Two cases of the development of anti-VIII antibody during the postoperative period are reported. The methods used to demonstrate the antibodies, the different aetiologies, the course and current treatment are reviewed. The cause was found in only one of the two cases.

The measurement of cardiac output by electrical impedance plethysmography (non-invasive technique) may be disturbed by a certain number of factors, including respiration. The authors sought to demonstrate that this factor could be eliminated during measurement calculations. By this method, in 18 adult subjects with coronary artery disease, 50 measurements during respiration and 50 measurements in apnoea (paired measurements) of stroke volume and of cardiac output were performed. Stroke volume was calculated using Kubicek's formula: SV = P(L2/Zo2) (dz/dt min)t Results were as follows: highly significant correlation between values for stroke volume obtained during respiration and in apnoea (r ;.9767; n=50; P < 0.001); highly significant correlation between values for cardiac output obtained under the same conditions (r = 0.9744; n=50; P < 0.001). The authors conclude that with the limits of certain technical conditions of measurement, respiration does not disturb measurements of stroke volume and of cardiac output by electrical impedance plethysmography.

Two groups of ten patients each, staying in a Intensive Care Unit, received exclusive parenteral alimentation with different concentrations of branched chain amino acids (BCAA). Group A received studied solution containing 12 g N (852 mmol) with 41,1 p. 100 BCAA. Group B received control solution containing 18 g N (1278 mmol) with 21,1 p. 100 BCAA. Every patient received 60 nonprotein Kcal x kg-1 body weight/24 hr. The study was performed on five days. Measured parameters were: daily (D0 to D5) N balance, blood urea N and total protein and urinary alpha amine N, and after therapy (D6) amino acid levels. Results have shown no statistical significant difference between both groups. N balance became less negative during the therapy. Amino acid levels were in the normal range and alpha amine urinary elimination remained low in patients with parenteral nutrition. These results indicate that 12 g (852 mmol) N in BCAA rich solution are as efficient as 18 g (1278 mmol) N in standard solution, allowing a N sparing.

A description of a selective ventilation distribution circuit (S.V.D.C.). The use of this circuit is illustrated by the description of 5 cases where the following were applied: 1 - the measurement of tidal volume of pressures for each lung during the respiratory cycle; 2 - regulation of tidal volumes to be as appropriate as possible for the patient; 3 - the application of different degrees of PEEP for each lung. This circuit is easy to construct and manipulate. It is connected to the patient via a double lumen endotracheal tube (Carlens) and uses only one respiratory.

Ricardo T., aged 20 years, was a passenger in a Varig air-craft which suffered an accident on July 11th 1973. A fire developed on board whilst the plane was in the air, at about 3 p.m. After emergency landing, rescue workers (firemen and emergency ambulance teams) discovered only two survivors amongst the 122 passengers. One was in his forties and died a few moments later. The other (Ricardo) was rapidly transported to the surgical and traumatological intensive care unit of the Henri Mondor Hospital. At the time of arrival, he was in stage 1 coma with skin burns (3rd degree), burns of the airway and a high carbon monoxide blood level. Treatment consisted of assisted ventilation for 24 hours, with intermittent bronchial lavage used to eliminate ashes and calcinated debris, then for 10 days, spontaneous ventilation without intubation, with a tele-expiratory counter-pressure of 4 milibar in a mini-chamber (globe) enriched in oxygen. Intravenous hyperalimentation was started during the first few hours, continued on the 24th day by enteral alimentation. Initial chest XRays showed heavy flaky appearances, predominantly in the hilar region, and more marked on the right. At about the 15th day, XRay showed fibrous with predominance of signs of the apex. These sequellae were confirmed by respiratory function tests which gave objective evidence of a diffusion disturbance with decrease in membrane permeability coefficient. Repetition of RFT indicated a decrease in mechanical problems. On August 31st (on the 51st day) Ricardo was able to return to Rio in a good general condition, dorso-lumbar burns having healed. There was a dysphonia of mixed origin: scarred infiltrate of the vocal cords, but with normal mobility, and a decrease in vital capacity of --30%. Seen again in September 1978, Ricardo was found to be well with normal activity and slight effort dyspnea. Chest XRays showed signs of residual fibrosis.

Almitrine was injected intravenously at a dose of 1 mg.kg-1 over a period of sixty minutes in eight men aged from 49 to 69 years suffering from chronic bronchitis and obstructive airway disease, with signs of chronic cor pulmonale. During the study, patients on artificial respirator were in stable ventilation. Measurements gave the following results: arterial pO2 rose at all the times of study (P < 0.02). Arterial pCO2 decreased, the difference being significant 20 minutes after the end of the infusion. Q tended to increase accompanied by a slowing in heart rate, an increase in cardiac index and in systolic ejection work (P < 0.01 at T60). Pw increased (with P < 0.05 at the 20th minute) and subsequently varied in the same direction in parallel with pulmonary resistance. The authors concluded that almitrine, apart from its well known effects on ventilatory mechanics, results in blood gas changes with are not directly correlated with variations in VE by direct action on pulmonary vascular flow with any notable improvement in the upper zones of the lung.