Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1991
Randomized Controlled Trial Clinical Trial[Role of vitamin C on adrenocortical effects of etomidate].
This study was carried out to assess whether the adrenal inhibition induced by etomidate could be prevented by associating ascorbic acid with etomidate, as a protective effect of ascorbic acid administered three hours after etomidate has been described. Sixteen ASA 1 or 2 patients, less than 65 years old, free of endocrine disease, were included. At induction of anaesthesia, eight of them (group B) were given an infusion of ascorbic acid 1 g, in 500 ml of 5% glucose. ⋯ Blood ACTH levels were also assessed by RIA at T0 and T4. The adrenal insufficiency at T4 had completely ended at T24. In fact, the relative decrease in cortisol levels was greater in patients treated with ascorbic acid (T4/T0: 47.6 +/- 9% in group A vs 76.5 +/- 33% in group B, p less than 0.05); this was suggestive of a higher degree of adrenal inhibition in patients receiving ascorbic acid.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1991
[Peripheral nerve block during ambulatory surgery of varicose veins].
This retrospective study of the 46 operations, carried out over a one year period for lower limb varicose veins using peripheral nerve blocks, included 45 patients (35 women and 10 men, mean age 49.3 years), all ASA 1 or 2, except for 4 elderly patients with a varicose ulcer (ASA 2 or 3). In 40 procedures, a sciatic nerve block combined with a "3 in 1" lumbar plexus block at the level of the groin (as described by Winnie) were used. In the remaining six, either a sciatic nerve block (short saphenous vein crossectomy; n = 3), or a "3 in 1" lumbar plexus block alone (short stripping of the long saphenous vein; n = 3) were required. ⋯ During the same period, nine similar procedures were carried out under general anaesthesia, and two under epidural anaesthesia. They included seven bilateral varicose veins, three patient refusals for peripheral nerve blocks, and one allergy to lidocaine. Already used for some procedures in orthopaedic and casualty surgery, peripheral nerve blocks seem to be well suited for surgery of unilateral varicose veins.
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Ann Fr Anesth Reanim · Jan 1991
[Hemodynamic effects of dobutamine in hyperkinetic septic shock treated with norepinephrine].
A prospective study of the haemodynamic effects of dobutamine was carried out in six men and four women suffering from hyperkinetic septic shock, already treated with noradrenaline and dopamine. All ten patients had septic shock, defined as a mean arterial blood pressure of less than 70 mmHg and an urine output under 15 ml.h-1, persisting despite fluid loading, associated with positive blood cultures, increased white blood cell counts, and a septic area. Initial treatment consisted in fluid loading, so as to increase cardiac output whilst keeping pulmonary wedge pressure (Ppw) between 8 and 10 mmHg. ⋯ The usual haemodynamic parameters were measured and calculated once a steady state had been obtained at each dose (within 20 to 30 min). Ppw was kept between 8 and 10 mmHg by fluid loading with a 4% albumin solution. At the beginning of the study, patients had a mean blood pressure of 78 +/- 6 mmHg, a CI of 4.8 +/- 1.5 l.min-1.m-2 and a RsaI of 1,285 +/- 341 dyn.s.cm-5.m-2 RsaI.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1991
Review Case Reports[Iterative epidural anesthesia after accidental dural puncture. Analysis with epidurography].
The case is reported of a 63-year-old man who was to undergo a gastrectomy for stomach carcinoma. An epidural catheter for postoperative analgesia (epidural morphine) was inserted into the T10-11 space prior to induction of general anaesthesia. Unfortunately, cerebrospinal fluid (CSF) surged back through the Tuohy needle, which was immediately withdrawn. ⋯ Another epidurography, 24 hours later, showed the same picture. The analgesic technique was therefore altered to subcutaneous buprenorphine. Careful management of this situation, in order to prevent total spinal anaesthesia, is discussed in the light of the literature.
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Ann Fr Anesth Reanim · Jan 1991
Comparative Study[Comparative value of clinical signs of difficult tracheal intubation in women].
A prospective study was designed to compare the value of clinical signs aimed to predict difficult intubation in women. A group of 663 women, scheduled for elective surgery, were assessed by an anaesthetist at the preanaesthetic visit. Following parameters were assessed: the degree of mouth opening, the chin-hyoid bone and the chin-thyroid cartilage distances, dental and facial abnormalities, age, weight. ⋯ Other clinical criteria (mouth opening, the chin-hyoid bone distance) had a lower sensitivities, but seemed more specific. Multivariate analysis showed that specificity could be improved (0.84) if the distance between the upper and lower incisor teeth (mouth opening) was associated with Mallampati's rank, without any loss in sensitivity. A simple chart is proposed to assess the risk of difficult intubation.