Annales françaises d'anesthèsie et de rèanimation
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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
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.
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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)
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Ann Fr Anesth Reanim · Jan 1988
[Respiratory obstruction during anesthesia in children with malignant mediastinal lymphoma].
In children with a malignant mediastinal lymphoma, acute respiratory occlusion can be a life-threatening complication during general anaesthesia. 26 cases have been reported since 1973, with five deaths. There were 23 boys for 3 girls, aged between 13 months and 18 years. The hazards of anaesthesia in these children are described. ⋯ General anaesthesia, carried out with the patient half-sitting, should be aimed at maintaining spontaneous breathing, and therefore muscle relaxants should be avoided. The anaesthetist should also be prepared to change the patient rapidly to a lateral or prone position; a rigid bronchoscope should always be at hand. Preoperative awareness of the risk of respiratory occlusion in these patients is essential so that the correct anaesthetic technique can be chosen and the postoperative course prepared.
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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.