Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1988
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative repercussions of general and spinal anesthesia on the psychological functions of the aged subject].
Although worsening cerebral function in the elderly is often said to be due to anaesthesia, it still remains to be proved that anesthesia acts on an elderly patient's psychological make-up. This study aimed to compare the psychological effects of general or spinal anaesthesia on 35 patients more than 70-yr old under repair of a subcapital femoral fracture, after having excluded 63 patients. They were randomly divided into two groups, the first receiving a spinal anaesthetic with 1.5 mg.kg-1 prilocaine (RA; n = 19), and the others a general anaesthetic with 5 mg.kg-1 thiopentone, dextromoramide, nitrous oxide and enflurane (GA; n = 16). ⋯ Individual psychological scores did not differ either. In the RA group, the postoperative tests were even better carried out than before surgery (p less than 0.05). It could therefore be concluded that anaesthesia alone has little impact on the psychological status of elderly patients.
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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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Ann Fr Anesth Reanim · Jan 1988
[Development of anesthetic technics for resection-anastomosis of the trachea].
A series is reported of 109 patients, 45 +/- 18 yr old, undergoing tracheal sleeve resection. 101 patients had iatrogenic tracheal stenosis, 5 tracheal cylindroma, 2 tracheal cancer and 1 tracheal trauma. 84 patients underwent preoperative laser coagulation to increase the airway internal diameter. Anaesthesia for the sleeve resection was induced by thiopentone, and maintained by an opiate, nitrous oxide and, if necessary, a volatile anesthetic. Patients were intubated, after having been given a muscle relaxant, with either a normal length and diameter tube with a low pressure cuff, or a narrow (internal diameter less than 6 mm) 50 cm long tube with or without a low pressure cuff. ⋯ Preoperative photocoagulation reduced the risk of induction and intubation; the choice of endotracheal tube no longer depended on the tracheal diameter, but on the method of ventilation chosen. However, HFJV has tended to be phased out, except for the surgery of lesions close to the carena; it has been replaced by intermittent positive pressure ventilation via long tubes. Because laser photocoagulation can completely cure small stenoses, these patients requiring surgery were those with long stenoses which were difficult to treat.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1988
[Systemic toxicity of local anesthetics. Pharmacokinetic and pharmacodynamic factors].
Local anaesthetics can have systemic adverse effects, mostly affecting the central nervous system and the heart. The physicochemical characteristics of the different local anaesthetics are recalled, for they determine the relationship between structure, activity and toxicity. The pharmacokinetic factors involved in the toxic effects of local anaesthetics, whether the drug is given in a single extravascular dose or, accidentally, within a blood vessel, are discussed. ⋯ Systemic maternal effects and transplacental passage probably explain their foetal toxicity. Specific toxic effects are seen with some drugs, such as methaemoglobinaemia and allergic reactions (rarely for amide agents). Overall, local anaesthetic accidents are rare, but they must be prevented.
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Ann Fr Anesth Reanim · Jan 1988
Case Reports[Obstetrical analgesia in a woman allergic to ethylene oxide].
A case is reported of a 28 year old woman, with untreated mitral valve disease and a professional allergy to ethylene oxide and phthalic anhydride, who presented with acute hydramnios during the 35th week of pregnancy. Emergency caesarean section having been decided on, a urinary catheter--sterilized by gamma rays and not ethylene oxide--was inserted; the gloves used had however been sterilized in ethylene oxide gas, and the patient rapidly presented with anaphylactic shock. ⋯ Caudal anaesthesia with 0.25% bupivacaine was used to complete the spinal analgesia and speed up cervical dilation. The child was delivered with forceps and the diagnosis of oesophageal atresia was confirmed.