Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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Narcotics are used in neuro-anesthesiology according to their pharmacology and their effects on cerebral physiology. New narcotics (fentanyl, sufentanil, alfentanil) fulfill the requirements of modern neurosurgical anesthesiology looking for quick awakening.
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Recent therapeutic advances in inotropic drugs and vasipressors uses allow a reappraisal of their indications during the perioperative period. Non-catecholamines vasopressors, ephedrine and phenylephrine, are particularly suitable for treatment of abrupt peroperative arterial hypotensions as observed during induction of general and medullar anesthesias. Cardiac arrest, peroperative anaphylactoid and toxic accidents are treated with epinephrine. ⋯ Inodilators (enoximone, amrinone and milrinone) ans nex dopaminergic compound (dopexamine) are powerful vasodilators agents to be introduced with care when association of amines and current vasodilators have failed. Finally, arterial pressure has to be maintained with norepinephrine after dopamine failure. Epinephrine remains last chance.
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This study included 20 children (average 8.5 years) undergoing surgery of the upper limb under brachial plexus block. A method of blocking the brachial plexus using an infraclavicular approach is described. Eighteen brachial plexus block were performed under general anesthesia. ⋯ Post-operative analgesia was satisfactory in all cases. In 10 cases a nerve stimulator was used. It is not necessary for the realization of a brachial plexus block, but the punction is easier under general anesthesia with this instrument.
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Psychiatric disorders are observable in Intensive Care Unit. They belong to all the psychiatric field. Their genesis depend on various factors that often work together and are interdependent: organic, demographic, psychological, environmental, procedural, hypnic. They can be considered as risk factors influencing the development of responses to stress (theory of stress).
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Comparative Study
[Physical and pharmacokinetic properties of anesthetics and sedatives used in neuroanesthesia and resuscitation].
Pharmacokinetics of anesthetic drugs are widely influenced by their physical properties. Lipo-solubility is the most important characteristic. ⋯ The concept of effective compartment allows a best understanding of relationship between concentration, intensity and duration of action of anesthetic drugs. Constant intravenous infusion route of anesthetic drugs administration requires to be discussed.