Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1982
Review[Postoperative weaning from mechanical ventilation in adults].
Pulmonary complications remain the most frequent of postoperative complications (32-60), especially after upper abdominal surgery (14-41). Chronic respiratory insufficiency (80) also continues to be a major risk factor, in spite of the progress made in both anesthesiology and postoperative care. In the immediate postoperative period, weaning from mechanical ventilation is one of the most dangerous phases of anesthesia (84). We discuss the importance of weaning procedures, in particular, in patients with a high risk of pulmonary complications.
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The authors have studied 18 cases of anaphylactic shock due to suxamethonium which occurred in eastern France during the period 1972-1980. The drug responsible was succinyl iodide in 15 cases and succinyl chloride in 3. Significant contributing factors were previous drug allergy, spasmophilia and skin hypersensitivity to histamine. ⋯ If only one test was positive, this had to be confirmed on two or even three occasions. Thus, 6 patients were tested once, 9 patients were tested twice and 3 patients were tested 3 times. In case of genuine anaphylaxis, suxamethonium must definitely be avoided, and the subject should be provided with an allergy card.
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Ann Fr Anesth Reanim · Jan 1982
Case Reports Comparative Study[Intraventricular morphine analgesia. Apropos of 4 cases, 1 with self-administration].
Intractable pain in four patients enduring disseminated cancer was treated by intraventricular morphine. For all these patients, previous efficiency of opiates therapy had been assessed by a positive trial of epidural injections of morphine. The latter method had to be stopped and a switch to intraventricular morphine was motivated in three cases by a local non-tolerance to the subarachnoid catheter. ⋯ Trial times were respectively of eight days, one month, two months and seven months, with a self administration system in one case. In comparison with the epidural and lumbar intrathecal administration of morphine, the authors insist upon the quality of analgesia obtained, the absence of respiratory depression, the comfort and minimal daily quantities of morphine injected (inferior to one mg daily in three cases). Enlightened by these four cases, the authors also discuss of relative importance of the spinal and brain mechanisms involved in morphine analgesia.
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Ann Fr Anesth Reanim · Jan 1982
Comparative Study[Nitrous oxide and pressures exerted on the trachea by endotracheal tubes. Study on a tracheal model].
The authors studied the effects of nitrous oxide diffusion, using a tracheal model, on the pressure of several endotracheal tube cuffs. Studies carried out showed an increase in volume and pressure of the cuffs related to time exposure and nitrous oxide concentrations used. Use of a self-controlled pressure cuff or filling the cuff with inspired gas composition should be of value to counteract or to prevent the diffusion effect.
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Caudal analgesia may be used with general anaesthesia in painful surgery. Caudal anaesthesias were performed by the authors, as the single anesthetic technic for digestive or orthopedic surgery in nine children. The technic is sure, efficient and without any complications. Caudal anaesthesia seems to be interesting in the child with respiratory pathology or with morphologic facial abnormalities.