Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1992
[Early biological markers of anaphylactoid reactions occurring during anesthesia].
Three markers of in vivo histamine release, i.e. plasma histamine and tryptase, and urinary methylhistamine, were assessed using sensitive radioimmunoassays in 18 patients who had experienced an adverse reaction to an anaesthetic agent. Controls were obtained from 35 patients following a general anaesthetic, which included a muscle relaxant, and who remained free from any adverse reaction. A first blood sample was obtained from all 18 patients a mean 25 +/- 26 min after the reaction, and a second one in thirteen a mean 120 +/- 65 min after the reaction. ⋯ Plasma histamine had a higher sensitivity than tryptase levels. Methylhistamine concentrations were only rarely of interest. There were no false positives with the three investigated markers.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1992
[Monitoring of intracranial pressure with intraparenchymal fiberoptic transducer. Technical aspects and clinical reliability].
A fiberoptic intracranial pressure transducer (Camino) was assessed prospectively in 100 patients. In all, 122 sensors were inserted intraparenchymally at the bedside, without the help of a neurosurgeon. Before the procedure, patients were given 2 to 4 mg of phenoperidine. ⋯ In trauma cases, there was also good correlation between mean ICP and the basal cistern obliteration score, finally, ICP became equivalent to mean arterial blood pressure in all brain dead patients. It is concluded that this system may be used in all cases where ICP requires to be monitored, even when the lateral ventricles are no longer visible, or when craniotomy has been performed. This will most probably result in a more extended use of ICP monitoring in neurosurgical intensive care.
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Eleven anaesthesia ventilators were instrumentally tested under various conditions. They included: Excel and Modulus II Plus (Ohmeda); 710 and Servo anaesthesia circle 985 (Siemens); Jollytronic (Soxil) and Elsa (Engström); SA2 and Cicero (Dräger); ABT 4,300 (Kontron); Monnal A and the prototype Alys (Taema). The test circuit comprised a two compartment model lung, a pneumotachograph, a pressure gauge in the "airway". ⋯ Increasing fresh gas flow raised the minute volume delivered in six ventilators. It is concluded that, during extreme ventilatory conditions, the inspired volume must be adjusted so as to maintain the inspired tidal volume. However, ventilators which increase inspiratory time in response to an increased mechanical load cannot be adjusted by this way.
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Ann Fr Anesth Reanim · Jan 1992
[Continuous venovenous hemofiltration after cardiac surgery. A retrospective study in 16 patients with multiple organ failure].
As intermittent haemodialysis in critically ill patients is often associated with circulatory instability and hypotension, pumped continuous veno-venous haemofiltration (CVVH) has been proposed as an alternative. This technique was used postoperatively in 16 cardiac surgery patients with cardiogenic shock (cardiac index < 2.2 l.min-1.m-2), anuria and multiple organ failure. A mean haemofiltration rate of 0.5 to 1 l.h-1 was used. ⋯ In addition, pH increased significantly from 7.13 +/- 0.1 to 7.30 +/- 0.04 (p < 0.001). These results were comparable with these of other authors regarding safety and efficiency of CVVH. The low patient survival rate (12.5%) was due to the severity of cardiac impairment.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1992
Comparative Study[Desflurane (I 653) and sevoflurane: halogenated anesthetics of the future?].
Sevoflurane is an halogenated methyl isopropyl ether. It is potent, non explosive and non flammable. It reacts with soda lime to form traces of a related ether which has not been shown to have any toxic effect on animals chronically exposed to it in a closed system. ⋯ Its MAC has been estimated to be about 7.2 vol % in man. Desflurane did not lead to any liver, lung or kidney injury in laboratory rats, even during hypoxia and enzyme induction. Desflurane undergoes little biotransformation, although the presence of volatile metabolites or covalent tissue-bound products cannot be excluded.(ABSTRACT TRUNCATED AT 250 WORDS)