European journal of anaesthesiology
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Comparative Study
Cardiac arrest related to anaesthesia: a prospective survey in France (1978-1982).
This report analyses the rate, predisposing factors, causes and outcome of 119 cardiac arrests related (totally or partially) to anaesthesia which were collected in France by a national prospective survey performed between 1978 and 1982. The overall rate of cardiac arrests occurring during anaesthesia and recovery was 1 per 1665 anaesthetics, resulting in death, before the 24th postoperative hour, in 56% of cases, i.e. 1 per 2900 anaesthetics. ⋯ The last were mainly related to unrecognized postoperative respiratory depression and resulted in the highest mortality. Cardiac arrests were less frequent in private hospitals than in teaching hospitals but the mortality rate was higher.
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Animal experiments and clinical trials have shown that the neonatal respiratory distress syndrome (RDS) can be treated effectively by surfactant replacement via the airways. This treatment facilitates the resorption of fetal pulmonary fluid, promotes uniform air expansion of the lungs, enhances gas exchange, reduces the protein leak across the alveolar epithelium, and prevents the development of bronchiolar epithelial lesions during artificial ventilation. Data from recent animal experiments indicate that surfactant replacement prevents epithelial lung lesions also during high frequency ventilation. Surfactant replacement restores blood gases to normal in adult experimental animals with severe respiratory insufficiency induced by repeated lung lavage, suggesting that this type of treatment might be effective in clinical adult RDS.
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Clinical Trial Controlled Clinical Trial
Heated humidification in major abdominal surgery.
The influence of heated humidification on body temperature and postoperative shivering was studied in 30 patients undergoing major intra-abdominal surgery. In the control group (I) the anaesthetic gases, administered in a non-rebreathing system, were humidified by a sponge heat and moisture exchanger. In group II the gases were humidified and heated to 37 degrees C and in group III up to 40 degrees C. ⋯ A good correlation was found between heat gain during the first hour of recovery, the feeling of cold and intensity of shivering. Intraoperative heat loss was minimal in all groups. Heated humidification had no statistically significant effect on the body temperatures or postoperative shivering and thus provided no additional advantage compared to the control group.
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A series of 52 patients in whom 0.5% bupivacaine was used to produce spinal analgesia for awake Caesarean section is described. Analgesia tended to be asymmetrical and of limited extent until the patients were turned from the left lateral to the right lateral position immediately after injecting the spinal solution. This movement produced a more symmetrical block with better cephalic spread. ⋯ The mean +/- SEM time to achieve maximal spread of analgesia was 17.5 +/- 0.6 min. The mean- +/- SEM time to the administration of the first postoperative analgesic was 163.5 +/- 7.0 min. The disadvantages of the technique were hypotension and the unpredictable spread of analgesia.
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Comparative Study
Histopathology of the spinal cord after intrathecal cocaine, bupivacaine, lignocaine and adrenaline in the rat.
Repeated intrathecal injections were given through catheters which had been chronically implanted in the subarachnoid space of rats. Injections were made of cocaine 0.25%, 0.125% and 0.0625%; bupivacaine 0.5%; lignocaine 2% and 0.5%; adrenaline 0.01% (1 in 10 000) and 0.002% (1 in 200 000); and sodium chloride 0.9%. Five injections of 35 microliter of each concentration of each drug were given hourly each day for two days to three rats. ⋯ There was no evidence of cell death. These changes were not seen in control animals in which catheters had been implanted but no injections had been given. The changes were mild and it is concluded that the agents tested caused no significant damage.