Therapie
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Several drugs and techniques have been developed to improve the quality of post operative analgesia. Opiates are always the first intention drugs, specially with new molecules (buprenorphine, nalbuphine ...). ⋯ The alpha 2 adrenergic agonists use must be specify. The patient auto-controlled administration and the transdermal administration of opiates are useful techniques to provide effective analgesia with optimal safety.
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Life-threatening accident during anesthesia scarcely happen but the consequences may be dramatic. We report our experience of an allergo-anesthesia consultation created since 1985 in Nice hospital. 452 patients have been investigated: 1) 109 for life-threatening anaphylactic and anaphylactoid drug reactions. They have been investigated by: skin tests intradermal reactions (IDR) and prick tests with substances used during anesthesia (drugs and latex) and for all the muscle relaxants; the radioabsorbent test (RAST) for the muscles relaxants, propofol and latex; the human basophilic degranulation test (HBDT) for all the other drugs. ⋯ In four of these, another muscle relaxant (skin test negative) was used without any trouble. For the other 13 who had shown a cross reactivity, all the muscle relaxants had been rejected and another anesthetic technique have been used: local anesthesia (3 cases), epidural (2 cases) associated or not with narcotics (propofol, midazolam), general anesthesia (propofol, midazolam, droperidol, phenoperidine). These drugs were all skin test negative.(ABSTRACT TRUNCATED AT 250 WORDS)
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Clinical Trial
[Hemodynamic and respiratory effects of enoximone in acute respiratory insufficiency of chronic obstructive bronchopneumopathy].
Hemodynamic effects and gas exchange were studied in twenty COPD patients undergoing mechanical ventilation before and 30 and 60 minutes after an intravenous administration of 1 mg/kg enoximone. Enoximone decreased significantly pulmonary arterial pressure and pulmonary vascular resistances without significantly decrease of systemic vascular resistances 60 minutes after a slight dose of 1 mg/kg. Right ventricular ejection fraction increased; O2 arterial pressure, CO2 arterial pressure, intrapulmonary shunt remained unchanged. We concluded that enoximone induced pulmonary vasodilation in patients with decompensated COPD and increased right ventricular function without deleterious effects in gas exchange.
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Several drugs are known to aggravate myasthenia gravis or to induce myasthenia like syndromes. Drugs which interfere with neuro-muscular transmission act either through a direct effect at the neuro-muscular junction or as with D. ⋯ For some drugs, the information available indicate their harmfulness in myasthenia gravis, so they are contraindicated. For others, the clinical effect is not so well established, nevertheless if necessary they can be used with caution.
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The authors report five cases of mydriasis induced by the use of transdermal scopolamine delivery systems. Anisocoria and narrow angle glaucoma were involved in four cases; in one case, the use of a strong dosage resulted in a bilateral mydriasis in a child.