Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1995
Case Reports[Prolonged neuromuscular block induced by mivacurium in a patient treated with cyclophosphamide].
A case is reported of prolonged neuromuscular block after mivacurium chloride for laparoscopic cholecystectomy, in a 45 years old patient, treated with cyclophosphamide for a Wegener's granulomatosis. The neuromuscular function monitoring by train-of-four showed a duration of action of 75 min after an intubation dose of 0.20 mg.kg-1. Additional bolus of 1 mg, corresponding to 25% of usual doses, every 10 or 15 min, were sufficient for maintaining muscle relaxation. ⋯ Plasma butyrilcholinesterases activity were reduced to a level of 50%. With reference to literature about succinylcholine, the responsibility of cyclophosphamide is likely, and discussed. This observation shows the value of monitoring the neuromuscular transmission.
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Infection is the main complication of external ventricular drainage (EVD). This retrospective study assessed the relationships between EVD duration, antibiotics and cerebrospinal fluid (CSF) infection. From January 1990 to December 1991, 53 neurosurgical patients, aged 7-76 years, a simplified acute physiological score (SAPS) of 1-20 and having a total of 64 EVD, were included in this study. ⋯ Their leucocyte count was increased. The glucose concentration was low, but the culture, remained negative. It is concluded that duration and rate of EVD influence more the incidence of infections than the systemic administration of antibiotics.
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Ann Fr Anesth Reanim · Jan 1995
[Ventilators for anesthesia. Models available in France. Criteria for choice].
This update article discusses the criteria for the choice of an anaesthetic machine and provides a short analysis of the main components of the models commercialized in France in 1994. The following items are considered: the design of the machine, the fresh gas delivery system, the anaesthesia breathing system(s), the ventilator and the waste gas scavenging system, the monitors associated with the machine and other criteria such as facility of learning to run the machine and of its daily use, ease of "in-house" maintenance and quality of after-sales service, cost of the machine and of its use (driving gas, disposable equipment).
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To define the part played by mild-to-moderate hypothermia in neuroprotection, it is necessary to take into account the thermoregulatory responses that occur in the normal human as the change in central temperature exceeds 0.2 degrees C. The mechanisms induced by cold are cutaneous vasoconstriction and shivering. They must be suppressed before starting controlled hypothermia. ⋯ The mechanism of neuroprotection from moderate hypothermia seems to be not only a decrease in cerebral metabolism, but also involves a specific action on some intra-cellular events such as the blocking of the release of glutamate and of lipid peroxydation in brain tissue. An indirect proof of the neuroprotective effect of moderate hypothermia is the increase in the neuronal damage induced by moderate hyperthermia. It is conceivable that moderate hypothermia could exert a better neuroprotective effect than the drugs having this reputation, such as barbiturates, isoflurane and propofol.(ABSTRACT TRUNCATED AT 250 WORDS)