Annales de l'anesthesiologie francaise最新文献

The aim of the present study was to validate the method for the measurement of total compliance proposed by Siemens Elema. The pressure and flow signals of the Servo 900 respirator are treated by an LMC-940 calculator. 1 - A study with a pulmonary model was used to evaluate the applicability of the measuring techniques used by the calculator. Tele-inspiratory alveolar pressure is accurately assessed for successive measurements of inspiratory resistance if the interruption of inspiratory flow is at least 0.3 seconds. Tele-expiratory alveolar pressure is accurately interpreted even if flow at the end of expiration is not nil, as long as airway resistance remains constant. The error in measurement of tidal volume depends in part upon the compression relaxation effect of gases in the circuit. The device used to compensate for this effect is effective up to a tele-inspiratory pressure of 1.96 kPa (20 cm H2O). Beyond this pressure, tidal volume is overestimated. The error is small, if the time after which the flow is integrated is 130 ms. For shorter periods, the correction is less satisfactory. 2 - A study in eight patients was used to assess the validity of 38 measurements of Ctot on the respirator in comparison with contemporary measurements made under static conditions using a syringe. A highly significant linear correlation was seen between values of Ctot obtained by the two methods: Ctot syringe = 0.94 X Ctot calculator = 0.55 ml.cmH2O-1. (n = 38; r = 0.95; p less than 0.001). The mean error of the calculator for a given reference value was 0.099 l.kPa-1 (9.65 ml.cmH2O-1). There was a closer relation for variations in Ctot recorded by the two methods. Variations were always in the same sense, and their correlation was highly significant (n = 19; r = 0.98; p less than 0.001). Such a method for the surveillance of compliance is extremely easy. The accuracy of absolute values for Ctot is limited but it is a reliable method for following variations in compliance and hence the effects of treatment.

This article first looks at the pharmacokinetics of local anesthetic agents injected intravenously, and then looks at the possible practical applications of this technique: the choice of a local anesthetic agent as a function of its toxic side effects, the use of lidocaïne in local and regional intravenous anesthesia, and the treatment of cardiac rhythm disorders. Finally the article envisages the pharmacokinetics of local anesthetic agents used in local-regional anesthesia. This depends on the following factors: the site of injection, the dosage, the speed of injection, the possible addition of adrenalin and the nature of the local anesthetic itself. On the basis of a personal study the authors underline the difficulty of being precise in the pharmacokinetics of local anesthetic agents injected by the peridural route continuously or discontinuously.

This report involves the study of skin test carried out using five antigens (tuberculin, candidin, -haemolytic streptococcus, staphylococcus albus, pertussis bacillus) in 33 patients hospitalised in a polyvalent intensive care unit with two criteria of inclusion:--associated excretion of 20 g of nitrogen or more per hour;--severe infectious complications (either pneumonia or septicaemia). Three patient populations were found: true anergism (all skin tests negative), relative anergism (one test only positive) and reactive (at least two tests positive). Results were analysed at two levels. With regard to the value of the tests: the use of candidin or of haemolytic streptococcus alone would have sufficed to classify the patients within the same groups with two exceptions. Secondly, from a prognostic standpoint, the study confirmed data in the literature. There was a significant between the anergic and reactive groups in terms of survival. This applied both to tests performed at the time of admission of the patients as well as those repeated one week later.

The authors report their experience of skin tests used to investigate cellular immunity in the detection of a high risk population pre-operatively. Over an 18 month period, 114 patients about to undergo major surgery were tested. The following three antigens were used: candinin, varidase and tuberculin. Results confirmed the prognostic value of these tests in terms of the overall prediction of complications (75 per cent in anergic individuals as against 24,4 per cent in reactors--p less than and deaths (45 per cent in anergics as against 8,5 per cent in reactors--p less than). Similarly, complications and deaths due to infection were more numerous in the anergic group (respectively 45 per cent and 25 per cent) than in the reactors (respectively 14,8 per cent and 4,2 per cent). Amongst factors which might influence the immune response, the authors studied successively the sex and age of the patients, pre-operative infection, neoplasia and undernutrition.

Among twenty six patients who have got tetanus the movement of the IgG, IgA, IgM, the serum complement, the number of B end T lymphocytes do not change in a significant way during the illness. There is no abnormally that could be considered as a consequence or a favorable factor of tetanus. In a group of patients being vaccinated against tetanus it has been given evidence that the specific antibodies develop much later than in a group of non vaccinated blood givers. Such an abnormal response can be found also in a third group of individuals without tetanus but whose ages in the average are comparable to these of the patients (69 years old). Thus, it seems not to be connected with tetanus itself but with the old ages of the patients.

A group of elderly (mean age: 75 years) patients undergoing a prothetic on the hip under analgesic anaesthesia using fentanyl by continuous infusion (7 micrograms.kg.h(-1)) was compared with a similar group receiving sequential analgesic anaesthesia using fentanyl (25 micrograms.kg as a bolus then 7 micrograms.kg(-1).2030mins(-1)). Comparison of the results obtained revealed a variation in mean cardiocirculatory parameters which was less marked in the group receiving fentanyl by infusion than in the group receiving it sequentially. The higher doses used in the sequential analgesia group led in the majority of cases to severe respiratory depression requiring its reversal by an antagonist or postoperative ventilatory assistance, whilst the use of fentanyl by infusion made it possible to reduce total doses of the drug and ensure adequate spontaneous respiration at the end of the operation.