Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1988
[Relation of the fall in PO2 in ventilation of the lower lung in pulmonary surgery and the preoperative distribution of respiratory function].
Hypoxaemia during one-lung ventilation is influenced by the anatomic distribution of lung perfusion and hypoxic vasoconstriction. This study aimed to assess whether preoperative selective bronchospirometry could predict the degree of peroperative hypoxaemia. Twelve patients scheduled for pneumonectomy, lobectomy, wedge resection or decortication were included in the study. ⋯ When both lungs were ventilated, mean PaO2 was 390.5 +/- 92.4 mmHg; during one-lung ventilation, it fell to 210.8 +/- 109.2 mmHg. Routine spirometry could not predict the magnitude of fall in PaO2; however, it was correlated with the bronchospirometric oxygen consumption of each lung (r = 0.83; p less than 0.01). The anatomical distribution of lung perfusion seemed to be the predominant factor influencing the decrease in PaO2 during one-lung ventilation.
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Ann Fr Anesth Reanim · Jan 1988
Randomized Controlled Trial Clinical Trial[Prolongation of spinal anesthesia with hyperbaric bupivacaine by adrenaline and clonidine in the elderly].
So as to determine the effects of vasoconstriction on the duration of hyperbaric bupivacaine spinal anaesthesia, a prospective controlled study was carried out on 80 ASA class II or III patients, aged 75 years or more, who were scheduled for spinal anaesthesia for lower limb surgery. They were randomly allocated to four groups, and were each given 3 ml (15 mg) of 0.5% bupivacaine in plain solution with 0.5 ml of 30% dextrose solution, together with 1 ml normal saline in group I, 0.15 mg clonidine in group II, 0.2 mg adrenaline in group III, and 0.4 mg adrenaline in group IV. All patients therefore received 4.5 ml of 0.33% bupivacaine solution in 3.3% dextrose solution. ⋯ Regression times tended to increase more with 0.4 mg than with 0.2 mg adrenaline. Significant prolongation of motor block was also associated with the addition of vasoconstrictors. It is concluded that addition of 0.15 mg clonidine or 0.4 mg adrenaline may be useful to increase duration of hyperbaric bupivacaine spinal anaesthesia in elderly patients.
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A seventeen year old boy sustained pelvic, femoral shaft and malleolar fractures in a road traffic accident. Six hours after admission, the patient became comatose (Glasgow coma score = 7); the coma worsened such that, 24 h later, the coma score was 4. Petechiae were present on the conjunctiva and anterior chest wall. ⋯ Ten months after the accident, magnetic resonance imaging showed a small ventricular dilatation due to subcortical atrophy. Residual ischaemic lesions and demyelination could be seen in the right centrum ovale and temporal lobe. The cerebral lesions contrast with the reversibility of the clinical state.
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Ann Fr Anesth Reanim · Jan 1988
Case Reports[Acute intracranial subdural hematoma after accidental dural puncture in epidural anesthesia].
A case is reported of an acute intracranial subdural haematoma following an accidental dural puncture during an epidural anaesthesia. A seventy-year old man, class ASA I, was operated on for prostatic adenoma under epidural anaesthesia. Dural puncture occurred during the first introduction of the needle into the L4-L5 epidural space. ⋯ After removing the epidural catheter at 24 h postoperatively, the patient received calcium heparinate. 26 h later, he complained of worsening headache and became rapidly deeply comatose. The computer tomographic scan showed air in the ventricles and a large right-sided subdural haematoma which was immediately discharged. Although the link between subdural haematoma and dural puncture is well known, the acuteness and rapidly fatal evolution of this case were exceptional and may have been facilitated by the big size of the needle, dehydration and hypercoagulability.
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Ann Fr Anesth Reanim · Jan 1988
[Use of new inotropic agents in the treatment of acute cardiac failure].
The drugs, new and old, useful in the treatment of acute cardiac failure, are reviewed in the light of its pathophysiological mechanisms and of the biochemical aspects of myocardial contraction. Two major classes of drugs are considered, those that stimulate cell membrane adenylcyclase, i.e. beta-agonists (dopamine, dobutamine and dopexamine) and alpha-agonists (glucagon, forskolin, calcium agonists) and those that inhibit the cellular phosphodiesterases, i.e. bipyridine derivatives (amrinone and milrinone) and imidazolone derivatives (fenoximone and piroximone). Virtually, all the inotropic agents act by increasing the entry of calcium into the cell by increasing the intracellular AMPc concentration. ⋯ Dobutamine exerts a potent positive inotropic action, with little effect on vascular tone and less tachycardia than with other catecholamines, resulting in only a slight increase in myocardial oxygen consumption. The dopamine analogue, dopexamine, increases renal blood flow, myocardial contractility and produces peripheral vasodilation. The haemodynamic effects of phosphodiesterase inhibitors are similar to those of dobutamine, except that these drugs are vasodilators, their positive inotropic properties are weak and their haemodynamic effects persist for at least 8 h after a single dose in heart failure patients.(ABSTRACT TRUNCATED AT 250 WORDS)