Annales françaises d'anesthèsie et de rèanimation
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In a semi-closed circle system, the inspiratory and expiratory limbs are completely separated and part of the patient's expired air recirculates. CO2 rebreathing is prevented by CO2- absorption with soda lime, which is always incorporated in such a circle. The inspiratory and expiratory valves ensure that gas flow is unidirectional and also prevent rebreathing, even at tidal volumes of 10 ml and ventilation frequencies of 60 c . min-1. ⋯ The values of expiratory resistance are within the recommended limits of the ISO; prewarming and humidification of the inspiratory gas mixture are sufficient without additional equipment. Standard monitoring of the circuit such as measurement of inspiratory O2 concentration and ventilation pressure, including a disconnection alarm, can be used for all age groups; spirometry or end-tidal CO2 measurements ensure normoventilation. The fresh gas flow required in a semi-closed circle system is about 2-4 1 . min-1, so that costs and environmental contamination with anaesthetic gases are relatively low in comparison with a semi-open system.
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Ann Fr Anesth Reanim · Jan 1985
Case Reports[Anesthesia for emergency cesarean section after uterine rupture associated with recent fracture of the cervical spine].
General anaesthesia with intubation is preferable for emergency Caesarean section, whilst epidural anaesthesia should be reserved for elective Caesarean section. The case of a patient who required emergency Caesarean section following uterine rupture is discussed. ⋯ This avoided tracheal intubation and the possibility of worsening the cervical fracture. The end result was satisfactory, both for the mother and the child.
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Ann Fr Anesth Reanim · Jan 1985
Review[Reassessment of the respective risks of anaphylaxis and histamine liberation with anesthetic substances].
A search of the French and English language literature of the last 20 years (1964-1984) yielded 975 cases of immediate anaphylactoid reactions due to anaesthetic drugs given parenterally. The accident mechanism was confirmed in only half the patients, and nearly always at a later date. The immunoallergological tests most often used in the diagnostic process were skin tests and Prausnitz-Küstner tests. ⋯ The signs most often described were cutaneous, cardiovascular, respiratory and occasionally gastro-intestinal. Whilst hypnotic drugs were responsible for cutaneous signs, muscle relaxants gave cardiovascular signs. A past history of drug allergy was found in 37% of cases, and atopy in 38%; virtually all patients had already had one or more anaesthetics.
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Ann Fr Anesth Reanim · Jan 1985
[Continuous peridural anesthesia in children less than 2 years old].
Continuous epidural anaesthesia was carried out in 23 children (age 13.9 +/- 6 months, weight 9.09 +/- 2.5 kg) scheduled for long surgical procedure (soft tissue release for club-foot, "pull-through" for Hirschsprung disease, various genito-urinary procedures). The lumbar epidural space was punctured under general anaesthesia with a 19 G Tuohy needle. A graduated 24 G polyurethane catheter was then inserted and fixed. ⋯ The catheter remained in situ 26.7 +/- 4.1 h. No complication was observed. Thus, during surgery, the need for systemic analgesia was avoided and a rapid and safe postoperative recovery was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1985
Clinical Trial Controlled Clinical Trial[Enflurane and extracorporeal circulation. Peripheral vascular effects and consequences of hypothermia on its biotransformation].
The effects of enflurane on systemic vascular resistance and venous capacitance, and its biotransformation during hypothermia, were studied in patients undergoing cardiovascular surgery with enflurane anaesthesia. When administered during cardiopulmonary bypass (CPB), cardiac regulatory mechanisms being therefore excluded, enflurane induced an arteriolar vasodilation related to the concentration inhaled. An inspired concentration of 2.5% in hypothermia (28 degrees C) produced a drop in systemic vascular resistance of 30% from control level. ⋯ The rise in the blood gas solubility coefficient during hypothermia was only partly balanced by haemodilution. Therefore, inspired enflurane concentration should be higher during hypothermic CPB than during normothermic anaesthesia to obtain the same effects. For the same amount of enflurane inhaled, the fraction of enflurane metabolized was higher in hypothermia than in normothermia, but the inorganic fluoride plasma concentration at its highest never reached the level of 50 mumol X 1(-1) regarded as the nephrotoxic threshold.