Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1990
Randomized Controlled Trial Clinical Trial[Evaluation of the risk of pulmonary complications after abdominal surgery].
Pulmonary complications are frequent after abdominal surgery. The object of this study was to evaluate the incidence and the predisposing factors of the postoperative pulmonary complications with a particular attention to their definitions. It included 146 patients. ⋯ Radiological complications were strongly correlated with postoperative hypoxaemia. Their incidence was not affected by a previous history of respiratory disease. Both radiological complications and hypoxaemia were predicted by age.
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Ann Fr Anesth Reanim · Jan 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of enoximone versus tobutamine in the treatment of low cardiac output after cardiac surgery].
Enoximone, a new cardiotonic agent not related to glycosides or catecholamines, has been suggested for treatment of low cardiac output syndromes occurring after cardiopulmonary bypass (CPB). The aim of the present study was to compare enoximone with dobutamine in the management of such cases. Twenty consecutive patients who had undergone cardiac surgery with CPB and who had a cardiac index (CI) less than 2.5 l.min-1.m-2, pulmonary capillary wedge pressure greater than 12 mmHg, and no renal failure, were randomly assigned to receive either enoximone (group E, n = 10) or dobutamine (group D, n = 10). ⋯ No other inotropic drug was used during the study period. The aim was to obtain an increase in CI greater than or equal to 30% at the end of the first hour of treatment. Excessive systemic hypotension with low SVR was treated with volume loading.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Risk of thrombosis in prolonged catheterization of the radial artery: comparison of 2 types of catheters].
The thrombosis rate after long-term cannulation of the radial artery was assessed prospectively in 48 intensive care patients randomly assigned to groupe A (polyethylene Leader-Cath 115-09 catheter; n = 50, aged 55 +/- 20 years, 74% male patients) or groupe B (Teflon Viggo Floswitch 4441 catheter; n = 48, aged 58.6 +/- 16 years, 73% male patients). Bedside angiography was carried out with 10 to 15 ml Hexabrix before removal of the catheter. The two groups were similar with regard to anthropometric parameters, used drugs, pathological events during the stay in ICU, arterial cannulation technique and its duration. ⋯ The duration of arterial cannulation did not influence the rate of thrombosis. However it was higher in males of Group A than in those of Group B (p less than 0.01), when heparin was not given (p less than 0.05); when vaso-active drugs were used (p less than 0.05); and when the time required for cannula insertion was greater than 5 min (p less than 0.01). It is concluded that Teflon catheters are more biocompatible than polyethylene catheters.
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Ann Fr Anesth Reanim · Jan 1990
Randomized Controlled Trial Comparative Study Clinical Trial Controlled Clinical Trial[Analgesic and respiratory effects of nalbuphine during the immediate postoperative period in thoracotomy].
As most patients undergoing pulmonary surgery by postero-lateral thoracotomy have decreased preoperative pulmonary function, efficient postoperative analgesia is mandatory. Nalbuphine, a new agonist-antagonist opioid analgesic, and nefopam were compared in a double blind trial involving 60 patients. Intravenous injections of 0.3 mg.kg-1 of either drug were started when the patient evaluated his pain as being above 60 mm on a visual scale graduated from 0 to 100 mm. ⋯ Nefopam led to a 30% increase in heart rate for one hour (p less than 0.01). Whereas patients given nalbuphine were more drowsy, although easily aroused, (p less than 0.001), nefopam was responsible for adverse effects (sweating, nausea, tachycardia with pallor, vertigo, malaise) requiring the exclusion of 7 patients from the study. Nalbuphine, although not ideal, would therefore seem to be a better analgesic than nefopam in thoracotomy patients.
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Ann Fr Anesth Reanim · Jan 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Alkalization of bupivacaine in the combination fentanyl-bupivacaine in epidural obstetrical analgesia].
A randomized double blind study was carried out to determine whether alkalization of a 0.25% bupivacaine solution in a fentanyl-bupivacaine mixture hastened the onset, and increased the duration and quality, of extradural analgesia during labour. The study included 120 women with uncomplicated full-term gestation. Prior to the extradural injection, 0.1 ml of either 8.4% sodium bicarbonate or normal saline was randomly added to 20 ml of 0.25% bupivacaine. ⋯ There were no statistically significant differences between the bicarbonate and control groups with regard to the speed of onset of analgesia (7.08 +/- 0.7 min vs. 6.78 +/- 0.6 min), its duration (123.6 +/- 10.7 min vs. 113 +/- 6.6 min), and the number of cases of inadequate pain relief (6 and 3 respectively). The rate of maternal adverse effects, and neonatal status, were similar in both groups. It can be concluded that alkalizing a 0.25% bupivacaine solution in a fentanyl-bupivacaine mixture for epidural analgesia in labour has no clinical value.