Cahiers d'anesthésiologie
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Cahiers d'anesthésiologie · Jan 1992
[Propofol anesthesia for ophthalmologic surgery in the elderly].
Fifty patients more than 70 years old, ASA I and II, NYHA I and II, were anaesthetized by propofol for cataract or retinal detachment surgery. Induction was carried out by a propofol slow injection (0.5-1 mg.s-1) until loss eyelash reflex (mean dose 0.728 mg.kg-1) and completed by fentanyl 2 micrograms.kg-1 and vecuronium 0.08 mg.kg-1. After intubation, anaesthesia was maintained with nitrous oxide and continued infusion of propofol (mean dose 4.48 mg.kg-1.h-1) according to haemodynamic parameters. ⋯ Recovery was as fast and good as in younger patients. It should be emphasized that propofol doses must be reduced in elderly patients so as to preserve a satisfactory haemodynamic stability. Reasons for increased sensitivity to propofol in elderly patients are briefly discussed.
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The first anaesthetic record was introduced into medical practice in 1940. Since then few changes have been made to it and it remains a rudimentary memorandum. ⋯ Apart from theoretical and experimental arguments, in practice one has to master the automatic collection of data, management of alarms and the technology of the networks involved in order to manage the flow of information by channelling it and organizing it into a hierarchy. Four other objectives can be added to the clinical recording and its medico-legal applications: anaesthetic cost evaluation, quality of care, research and clinical teaching which will provide the basis of anaesthetic epidemiological research.
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Combined spinal and epidural anaesthesia was described by P. Moulaert. After searching the epidural space, a spinal needle is introduced through the Tuohy needle for performing the intrathecal block; then an epidural catheter is put for the postoperative analgesia. The author from his own experience of this regional anaesthesia proposes modifications of the Tuohy and spinal needles to improve the technique.
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Two new vaporizers for isoflurane were tested and verified with very low flows: Ohmeda Tec 5 and Penlon PPV Sigma vaporizers. This work completes a previous one [1]. ⋯ The Penlon vaporizer gave pretty good results too. However a gas flow with vibratory component can affect the result by decreasing dramatically the concentration of inhaled isoflurane.