Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1984
Randomized Controlled Trial Comparative Study Clinical Trial[Effects on muscular and general proteolysis in burn patients of a solution enriched with branched amino acids].
In order to assess the effects of a branched chain amino acid (BCAA) enriched solution on urinary nitrogen loss and muscle protein breakdown, 22 burnt patients were randomly divided into two groups immediately after hospital admission: 11 patients received a 22% BCAA amino acid solution, 11 patients received a 41% BCAA amino acid solution. Nitrogen intake was 0.2 g per day during the first 4 days in each group. Urinary total nitrogen, urinary creatinine and urinary 3,methylhistidine (3,MeHis) were measured for 4 days. ⋯ The 3,MeHis/nitrogen ratio on day 1, day 2 and during the whole study period, as well as the 3,MeHis/creatinine ratio on day 2, were significantly lower in the 41% BCAA group. These results were in agreement with a decrease in muscle/whole body urinary nitrogen excretion. However, no beneficial effect upon nitrogen loss or nitrogen balance was shown by using the 41% BCAA rich amino acid solution.
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Ann Fr Anesth Reanim · Jan 1984
Case Reports[Pneumomediastinum and subcutaneous emphysema after translaryngeal jet ventilation].
The use of emergency transtracheal jet ventilation in a 62 year-old female with laryngeal papillomatosis and respiratory distress is reported. Adequate ventilation of the lungs with an intermittent jet of oxygen under high pressure (5 bar) allowed anaesthesia and surgery to be carried out. Pathogenesis of the mediastinal and subcutaneous emphysema discovered at the end of the procedure is discussed.
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Ann Fr Anesth Reanim · Jan 1984
[Anesthesia and intensive care in cardiac surgery. Activity at the French centers in 1982].
A national survey was carried out to inquire about the practice of anaesthesia and surgical intensive care in cardiac surgery in French hospitals. In 1982, 15,797 surgical procedures with cardiopulmonary bypass were collected; 1,360 and 555 were performed in children and infants respectively. Coronary surgery accounted for 46% of the total. ⋯ With the exception of arterial blood pressure monitoring, there was no consensus on the method or the extent of monitoring of patients undergoing cardiac surgery. A Swan-Ganz catheter was only used in 18% of cases. Neuroleptanalgesia was the anaesthetic technique most often used.
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Ann Fr Anesth Reanim · Jan 1984
[Urinary excretion of creatinine and 3-methylhistidine in multiply injured patients].
The daily urinary excretion of 3,methylhistidine (3,MeHis) was measured in eight severely injured patients for periods of at least two weeks to at most one month after the trauma. The patients were fed with 0.20 +/- 0.05 g X kg-1 X 24 h-1 of nitrogen and 25 +/- 5 kcal X kg-1 X 24 h-1 given as glucose. The pattern of 3,MeHis and creatinine excretion as well as the weight loss suggested the following: 1) the muscle protein breakdown in these patients was approximately twice the normal value (the mean 3,MeHis excretions were respectively 7.98, 7.21, 6.26 and 5.14 mumol X kg-1 X 24 h-1 for the four week study period, compared with the normal value of 3.73); 2) the creatinine excretion decreased slowly. ⋯ Various factors could be responsible for increasing and extending the muscle protein catabolism: the importance of muscle damage, the metabolic response to neurotrauma, sepsis and prolonged immobilization. In these conditions, it would seem useless and even harmful to try, at all costs, to obtain a positive nitrogen balance. The authors suggest therefore an average intake of 0.2 g X kg-1 X 24 h-1 of nitrogen, which should be sufficient to meet the requirements for protein synthesis.