Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1983
Case Reports[Acute hepatic steatosis of pregnancy in an Addisonian patient].
A case is reported of acute fatty liver occurring in an Addisonian woman with a twin pregnancy. It is pointed out that Sheehan's syndrome or acute fatty liver of pregnancy is an exceptional cause of jaundice in pregnancy. ⋯ The best treatment is delivery by caesarean section, together with symptomatic treatment of the complications. In case of jaundice of unknown aetiology in late pregnancy, the advantages of an early diagnosis by transjugular hepatic biopsy are discussed.
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The cardiovascular effects of vecuronium (Organon NC 45 or Norcuron) in man were determined through different protocols using continuous recording of heart rate, arterial blood pressure and parameters obtained by a Swan-Ganz catheter. In healthy anaesthetized patients (n = 23), the effects of a dose of 0.1 mg X kg-1 pancuronium (group A) were compared to those of two doses of vecuronium: 0.1 mg X kg-1 (group B) and 0.3 mg X kg-1 (group C). Pancuronium induced an increase in heart rate (+12%), arterial pressure (+16%) and cardiac index (+8%). ⋯ The doses were approximately equipotent in groups A, B and C, whereas the dose of 0.3 mg X kg-1 in group G is about 10 times the 90% effective dose of vecuronium. In geriatric patients with per- or postoperative circulatory deficiency (group H; n = 10, mean age 83 yr), no hemodynamic side effects were observed. Vecuronium seems to be a non-depolarizing neuromuscular blocking agent devoid of cardiovascular side-effects at the generally usual doses.
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Ann Fr Anesth Reanim · Jan 1983
Comparative Study[Comparative study of ORG NC 45 and pancuronium during anesthesia].
The muscle relaxant effects of ORG NC 45 and pancuronium were compared in anesthetized patients with normal liver and renal functions. In all patients, the muscle relaxant effect was monitored by measuring the strength of the adductor pollicis muscle elicited by supramaximal stimulation of the ulnar nerve at the wrist. Different modes of administration of the muscle relaxants were used. ⋯ The dose of 100 micrograms X kg-1 produced adequate conditions for tracheal intubation 3 to 4 min after the administration of the muscle relaxant. The recovery of the muscle strength to 75% of control value was achieved 46 min and 100 min after a single dose of 100 micrograms X kg-1 of ORG NC 45 and pancuronium respectively. The interval of time between repeat injections averaged 20 min for ORG NC 45 and 40 min for pancuronium.
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Two cases of colonic gas explosion during surgery are reported. The treatment of the lesions required a partial colectomy in one case and a total colectomy in the other case. The different factors involved in such accidents are discussed. ⋯ During anaesthesia the oxygen-nitrous oxide mixture increases the intestinal concentration of these two major combustive gases. Electrocautery provides the spark triggering the explosion. The use of mannitol for colonic preparation should be questioned; the use of electrocautery to open the colon is advised against.
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A prolonged brachial plexus block with bupivacaine hydrochloride is described. Anaesthesia was induced with 40 ml of a solution made of equal parts of 0.50% bupivacaine hydrochloride and distilled water. Reversal of the motor block began 24 h later. ⋯ Whether this low osmolality caused nerve lesions was unknown. Postoperative exploration revealed a bilateral slowing down of conduction in the brachial plexus of this 73 year old patient. The importance of this finding could not be assessed.