Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of extrapleural and intrapleural analgesia with bupivacaine after thoracotomy].
To compare the analgesic and the ventilatory effects as well as blood concentrations of bupivacaine, administered either in the extrapleural or interpleural space after posterolateral thoracotomy. ⋯ Extrapleural administration of bupivacaine provides better analgesia as the anaesthetic agent comes in closer contact with intercostal nerves and with lower risk of loss of agent through the pleural drainage. Therefore its use is recommended preferentially over the interpleural route for analgesia after posterolateral thoracotomy.
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Ann Fr Anesth Reanim · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of effects of aprotinin and tranexamic acid on blood loss in heart surgery].
To compare the efficacy of aprotinin (APR) and tranexamic acid (TRA) in reducing blood loss and transfusion requirements after cardiac surgery under extracorporeal circulation (ECC). ⋯ Both APR and TRA decrease blood loss. APR is more efficient after CABG than TRA as far as blood loss is concerned, whereas the transfusion requirements are similar. As APR is about 100 times more expensive and carries a risk for allergic reactions, its use in a high dose regimen is only recommended for reoperations, in patients treated with salicylates and in case of sepsis.
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Ann Fr Anesth Reanim · Jan 1995
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of platelet-rich plasma on hemostasis and transfusion requirement in vascular surgery].
To assess the effect of intraoperative autologous platelet-rich plasma (PRP) transfusion on haemostasis, blood loss and blood requirements during vascular surgery. ⋯ This study demonstrates that intraoperative infusion of autologous PRP does not decrease blood loss and homologous transfusion requirements in patients undergoing elective abdominal infrarenal aortic aneurysmectomy. This result can be related to the relatively moderate enrichment in platelets obtained with the centrifugation speed used in this study.
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Sevoflurane, a methylethylether halogenated solely with fluorine, is characterized by a low blood/gas solubility (blood/gas partition coefficient = 0.65). This feature allows in a more rapid uptake and elimination than with more soluble agents. MAC is about 2 vol% in young adults and 2.5 vol% in children of more than 6 months of age. ⋯ In adults, recovery is more rapid than with isoflurane. In children, sevoflurane seems a promising agent owing to its good acceptance for mask induction, as well as its favourable haemodynamic profile. However due to its rapid elimination, analgesic drugs should be administered early enough to decrease the incidence of postoperative pain.
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Ann Fr Anesth Reanim · Jan 1995
Review[High frequency jet ventilation combined with conventional mechanical ventilation in the treatment of adult respiratory distress syndrome].
Better understanding of the physiopathology of ventilatory mechanisms associated with ARDS and the recent re-evaluation of the iatrogenic potential of mechanical ventilation (MV) brings us closer to the best suited ventilatory mode for these patients. In severely ill ARDS patients, only a small lung volume is ventilated, and remains available for the totality of the gas exchanges (baby lung concept). The goal of MV is to restore and maintain an optimal exchange volume while limiting mechanical agression of the lung tissue. ⋯ Though HFV alone can maintain lung volumes oscillating around a mean value, it cannot re-expand atelectatic areas. The small VT's used are insufficient to overcome these area's elevated opening pressures. Volume recruitment by periodic hyperinflations, or sighs, though generally considered useless in conventional MV, have been shown to be of great benefit in HFV.(ABSTRACT TRUNCATED AT 400 WORDS)