Annales françaises d'anesthèsie et de rèanimation
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Rapid fluid infusion remains the cornerstone for therapy of hypovolaemic shock. The principal limitations of flow rate are governed by the four variables of Poiseuille's law: tube internal diameter and length, viscosity of the fluid passing through the tube, and the pressure gradient between the two ends of the tube. ⋯ Dry-heat warming devices and microfiltration, to remove microaggregates and prevent non haemolytic febrile transfusion reactions, seem necessary when carrying out rapid transfusions. However, the use of microaggregate filters could be avoided by the routine production of leukocyte-poor red blood cell concentrates.
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A new type of airway has been widely used for two years, throughout hospitals in the United Kingdom. Designed and created since 1983 by Dr AIJ Brain, the Laryngeal Mask Airway (LMA) is a compromise between the endotracheal tube and the face-mask. Blindly inserted in an anaesthetized patient, without either a laryngoscope or neuromuscular blockade, it provides a good airway in almost all cases. ⋯ The spontaneously breathing patient, undergoing elective surgery for 15 to 60 minutes, in supine position, who would ordinarily be managed with a face-mask is the more likely candidate for the LMA. But, longer procedures, in lateral or prone position, with controlled ventilation can usually be carried out using the Brain's device. More effective and less demanding than the facial-mask, much less hurtful than the endotracheal tube, the Laryngeal Mask is potentially an important and valuable addition to anaesthetic care.
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Regional anaesthesia has an important place in the management of elderly patients. Its selection depends on the type of surgery, the skills of the anaesthetist as well as the status and the will of the patient. Regional anaesthesia should no longer be considered as a challenger but rather as a complement to general anaesthesia, especially in the elderly.
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Numerous anaesthetic techniques exist for a patient who presents with a difficult endotracheal intubation. They all require an anaesthetic protocol which cannot be improvised. ⋯ When a fiberoptic bronchoscope is not available, several alternatives can be suggested: local anaesthesia of the glottis, retro-molar and retrograde intubation, or the use of a guide threaded over a lighted stylet; these techniques can be used in an anaesthetized patient breathing spontaneously. In the paralyzed patient impossible to intubate, various trans-laryngeal techniques of ventilation can be used in emergency: jet ventilation via the trans-crico-thyroid route, the use of a cricotomy cannula, or a minitracheotomy set.
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Ann Fr Anesth Reanim · Jan 1990
Comparative Study[Comparison of the pharmacokinetics of etomidate in children and in adults].
Etomidate pharmacokinetics were compared in 12 children (P group) (age 7 to 13 years, weight 22 to 48 kg) and in 4 adult women (A group) (age 28 to 52 years, weight 46 to 72 kg), A. S. A. 1, undergoing minor non abdominal surgery. ⋯ No age-related difference was found inside P group with regard to pharmacokinetic parameters. In conclusion, a 30% higher etomidate bolus dosage is required in children than in adults to achieve similar plasma concentrations, due to a higher volume of the initial compartment. In comparison to adults the higher clearance suggests higher maintenance dose requirements in children.