Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1988
[Continuous monitoring, in the adult, of arterial oxygen saturation during apnea following intubation].
Twenty ASA I or II patients were studied to assess the safety of oxygenation for 4 min prior to intubing, so as to prevent the hypoxaemia related to tracheal intubation. The arterialized capillary blood saturation (Spo2) was continuously monitored with a pulse oximeter Nellcor 100 equipped with a finger probe. Patients spontaneously breathed oxygen (FIO2 = 1) while anaesthesia was induced with pancuronium bromide, thiopentone and fentanyl. ⋯ After the 5 min apnoea period, no saturation was below 95% (mean +/- SD = 98.89 +/- 1.66); at this time, Sao2 and Spo2 did not significantly differ (p less than 0.001). In one case, apnoea had to be interrupted, because of the occurrence of arrhythmias, unrelated to a blood gas disorder (PaO2 = 225 mmHg; Paco2 = 34 mmHg; SaO2 = 100%; pH = 7.44). This study confirmed the efficacy and safety of oxygenating for 4 min before intubation.(ABSTRACT TRUNCATED AT 250 WORDS)
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The prevention of toxic accidents due to local anesthetics is simple. The doses used must be carefully selected according to the drug chosen, the areas to be anaesthetized, and whether or not the local anaesthetic solution contains adrenaline. Continuous infusions of local anaesthetics should be used with great care. ⋯ Using a test dose of adrenaline to detect accidental vascular puncture is simple, but not foolproof (patients treated with beta-blockers, obstetrical cases). The slow injection of local anaesthetics is the best way of preventing this type of accident. Finally, the technique for intravenous regional anaesthesia must be very strict.
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Ann Fr Anesth Reanim · Jan 1988
[Use of new inotropic agents in the treatment of acute cardiac failure].
The drugs, new and old, useful in the treatment of acute cardiac failure, are reviewed in the light of its pathophysiological mechanisms and of the biochemical aspects of myocardial contraction. Two major classes of drugs are considered, those that stimulate cell membrane adenylcyclase, i.e. beta-agonists (dopamine, dobutamine and dopexamine) and alpha-agonists (glucagon, forskolin, calcium agonists) and those that inhibit the cellular phosphodiesterases, i.e. bipyridine derivatives (amrinone and milrinone) and imidazolone derivatives (fenoximone and piroximone). Virtually, all the inotropic agents act by increasing the entry of calcium into the cell by increasing the intracellular AMPc concentration. ⋯ Dobutamine exerts a potent positive inotropic action, with little effect on vascular tone and less tachycardia than with other catecholamines, resulting in only a slight increase in myocardial oxygen consumption. The dopamine analogue, dopexamine, increases renal blood flow, myocardial contractility and produces peripheral vasodilation. The haemodynamic effects of phosphodiesterase inhibitors are similar to those of dobutamine, except that these drugs are vasodilators, their positive inotropic properties are weak and their haemodynamic effects persist for at least 8 h after a single dose in heart failure patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1988
[Respiratory obstruction during anesthesia in children with malignant mediastinal lymphoma].
In children with a malignant mediastinal lymphoma, acute respiratory occlusion can be a life-threatening complication during general anaesthesia. 26 cases have been reported since 1973, with five deaths. There were 23 boys for 3 girls, aged between 13 months and 18 years. The hazards of anaesthesia in these children are described. ⋯ General anaesthesia, carried out with the patient half-sitting, should be aimed at maintaining spontaneous breathing, and therefore muscle relaxants should be avoided. The anaesthetist should also be prepared to change the patient rapidly to a lateral or prone position; a rigid bronchoscope should always be at hand. Preoperative awareness of the risk of respiratory occlusion in these patients is essential so that the correct anaesthetic technique can be chosen and the postoperative course prepared.
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A case is reported of a 37 year old man who was involved in an accidental shell blast. He was admitted with black tattooing of his face, forearms, hands and legs. Repair of the severe ocular lesions and the surgical debridement of his burns required general anaesthesia. ⋯ The amount of DNB absorbed had been unknowingly reduced by the surgical brushing of the burned skin. The classical treatment of methaemoglobinaemia, associated with two plasmaphereses to remove the toxic substance, were successful. Normal arterial blood gases associated with chocolate brown coloured arterial blood should make one suspect methaemoglobinaemia.