Annales de l'anesthesiologie francaise最新文献

The analgesic action of fentanyl administered by epidural injection in a dose of 0.2 mg diluted in 10 ml of physiological saline proved to be satisfactory in 21 patients who had undergone abdominal surgery. The mean duration of analgesia was 6 hours. The subjective improvement was associated with an increase in V.C. (congruent to 30%) and good tolerance of postoperative chest physiotherapy. Despite the absence of respiratory depression, the existence of drowsiness is suggestive of central impregnation the degree and role of which remain to be defined.

The action of cimetidine on gastric acid secretion being perfectly known, the authors sought to confirm the possible efficacy of a single injection of cimetidine, by the intramuscular route, combined with the premedication, on the reduction in gastric secretion during the operative period. Fifty patients undergoing routine surgery were divided into two groups at random. One group was used as a control. The patients of the other group received 200 mg of cimetidine by intramuscular injection one hour before surgery. In all patients, gastric pH was measured by a colorimetric technique at the time of induction, one hour after induction and two hours after induction. The number of samples with a pH of less than 2.5 was very significantly decreased (p less than 0.01) at the time of the induction of anaesthesia. The authors suggest the administration of cimetidine as pre-anaesthetic premedication in all cases where a Mendelson's syndrome is particularly feared.

A pharmacokinetic study of amikacin was carried out in 12 neonates hospitalized in the intensive care unit. Serum amikacin levels were measured using a bacteriological method after one of several intramuscular injections of 7.5 micrograms/kg. Serum levels were greater than 10 micrograms/ml during the first three hours in 11 cases with values greater than or equal to 30 micrograms/ml. during the first two hours in five cases. The half life was measured in five patients and varied between three and eight hours. The plasma clearance was between 8.9 and 14 mil per minute per 1.73 m2. There is an unpredictable accumulation of this antibiotic especially in premature babies aged less than five days with a birth weight less than two kg. This accumulation is transitory when the clinical evolution of the case is favorable but it can be prolonged in unfavorable cases. The elimination of amikacin depends mainly on a patient's renal function. So, because of the risk of ototoxicity, the dosage should be reduced to 10 mg per kg-1 per 24 h-1, with measurements of the serum peak level and the level just before the following injection.

Althesin (alphaxalone: alphadolone acetate) and the new water-soluble steroid intravenous anaesthetic agent minaxolone have been administered by continuous infusion to supplement nitrous oxide: oxygen anaesthesia in 20 patients. Plasma drug concentrations were estimated in blood samples taken during and following cessation of the infusion. In both group (Althesin: n = 11, minaxolone: n = 9), there was no evidence of drug accumulation within the plasma. The decay in the plasma drug concentrations after the infusion could be fitted to a bi-exponential equation, indicating that the steroids were distributed according to an open two-compartment pharmacokinetic model. The prolonged recovery following minaxolone may be related to its water-solubility, and to a larger volume of distribution of the drug. Studies gas chromatography: mass spectrometry to analyse samples of blood and urine have confirmed than Althesin and minaloxone both undergo biotransformation in the body. Hepatic conjugation to glucuronic acid is of importance in the excretion of the lipophilic agent, Althesin.

Cellular immunity is studied by intradermal reaction to phytohaemagglutinin (four concentrations: 1, 2, 5 and 10 infinity g), the response to which at the 24th hour gives information concerning macrophage power and at the 48th hour the functional value of the T lymphocytes. Such a study was carried out in three groups of patients: 1st group (n = 20): general anaesthesia without surgery, duration less than 30 minutes; 2nd group (n = 10): general anaesthesia without surgery, duration greater than 2 hours; 3rd group (n = 20): general anaesthesia with surgical procedure, duration greater than 2 hours. In all groups, the results showed highly significant immune depression at the 24th hour, certainly linked to a depression of macrophage power. This depression persisted at the 48th hour, but less markedly and less significantly, which could not be interpreted as definite evidence of depression of the T lymphocytes. Surgery would not appear to have played any additional role to anaesthesia in this immune depression, nor did the duration of anaesthesia. In a 4th group (n = 10) treated with vitamin A and undergoing anaesthesia with surgery lasting for more than two hours, no immune depression was seen.

Transfusional malaria is a disease in continual increase because of the greater number of international journeys and because of the insufficient prophylaxis at the present time. The authors report a new case which occurred in Limoges due to Plasmodium falciparum. The blood-donor was cambodgian and specific immunological tests were positive on this serum. Any fever, without evident cause, happening after blood or blood-derivative transfusion must suggest transfusional malaria. This diagnosis must be quickly confirmed by parasite detection in the blood and a good and efficient treatment will be easy. Maybe soon a culture of human Plasmodium in human red cells will make possible an efficient prophylaxis using a cheap fluorescent antibody test.