Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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Bolus injections of lidocaine are commonly used during neuroanesthesia to prevent or treat ICP elevations caused by tracheal or painful stimuli. Lidocaine can also be employed in case of hard intracranial hypertension, when the usual therapy fails. With continuous perfusion, at high doses, of this agent, a state of lidocaine anesthesia can be induced which is more readily reversible than barbiturate anesthesia. ⋯ Experimental works point to the effectiveness of i.v. lidocaine to prevent ischemic lesions secondary to a cerebral artery occlusion. This protective effect may result from some properties exhibited by lidocaine and not by thiopental: stabilisation of transmembrane ionic fluxes, inhibition of leucocytes intravascular sticking and tissular migration. So, i.v. lidocaine seems help to preserve or improve cerebral perfusion pressure and in cases when the latter decrease below the critical threshold, to protect against cerebral ischemia.
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The effects on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and EEG monitored by Cerebral Function Monitor (CFM) were compared after bolus administration of mannitol (n = 55) and thiopentone (n = 67) to control intracranial hypertension in 18 severely head injured patients. Mannitol increased CPP in 89% of occasions and thiopentone in only 54% (p < 0.001). Thiopentone caused a mean increase in CPP +0.6 kPa (+5.0 +/- 1.6 mmHg) when the minimum pre-bolus voltage of CFM was above 4 microV and a fall in CPP -0.5 kPa (-4.1 +/- 1.6 mmHg) when cortical electrical activity was already severely depressed (p < 0.0002). ⋯ This different effect on CPP was due to a significantly greater fall in mean arterial pressure in the thiopentone sub-group -1.6 versus -0.3 kPa (-12.4 +/- 1.5 mmHg, -2.8 +/- 1.2 mmHg; p < 0.001). Severe and unpredictable hypotension occurred, particularly in the thiopentone low CFM sub-group. This symptomatic therapy seems inadequate but a targeted treatment of intracranial hypertension could be possible only with a more sophisticated monitoring, including continuous data on cerebral blood flow and adequacy to metabolic demand.
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A new apparatus for anaesthesia has been developed for disaster situations. A turbine pushes room air through a halothane vaporizer to a modified D. Mapleson system. ⋯ Oxygen monitoring was performed with percutaneous PO2, SaO2, FiO2. Only one patient with cardiac disease needed oxygen adjonction (2 l.min-1) to raise his SaO2 level above 95%. Thus it is possible to have the optimum FiO2 with the lowest amount of halothane and oxygen.
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Celiac plexus block is a good alternative of pain treatment in upper abdominal pain. Neurolysis of the celiac plexus by the percutaneous posterior route used CT guidance in 8 patients. Pain relief was obtained in 5 of 7 patients (70 per cent); no complication occurred.