Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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Comparative Study
[Spinal anesthesia at T12 or T10 level with hyperbaric bupivacaine 0.5%: value of determining the useful dosage according to the weight].
A retrospective study was carried out on anaesthetic records concerning spinal anaesthesia with hyperbaric bupivacaine 0.5% in urologic surgery. Three doses were utilised: slight (< 0.19 mg.kg-1), mean (0.19-0.21 mg.kg-1) or important (> 0.21 mg.kg-1) for two different levels: T12 or T10. ⋯ Failures are perhaps more frequent with slight doses. Mean doses, 0.20 mg.kg1, seems to be recommended.
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In order to estimate the preoperative evaluation of the respiratory risk, a well adapted clinical examination associated with a routine pulmonary function test (VC, FEV1) can be sufficient. Although some patients with cardiopulmonary disorders or candidates to lung resection need more complex assessments: the flow-volume loop to detect small airways obstruction (MEF 50%, MEF 25%), measure of bronchial hyperreactivity to predict bronchospasm during anaesthesia, residual volume for the diagnosis of emphysema, diffusing capacity (DCO) to discover lung fibrosis: these parameters disruption always make the pronostic worse. ⋯ So it is possible to use in addition the results of exercise testing to determine cardio-respiratory performances and maximal oxygen consumption (VO2MAX) which seem better correlated with mortality and post-operative lung surgical complications. Preliminary results of our study concerning thirty patients hospitalized in Besancon-St-Jacques Hospital, agree with the hypothesis that exercise testing is an important criterion in the pre-operative evaluation and to predict post-operative mortality and morbidity of patients candidates to thoracic surgery.
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A man 55 years old reached of chronic bronchopneumopathy was underwent a subumbilical surgery under an epidural anesthesia. The puncture has been realized at the level of the space L3-L4, with the location of an epidural catheter after negative aspiration test. The local anesthetic with lidocaine 2% (12 ml) Ten minutes later, the patient presented cardiac arrest that evaluated favourably under the cardiocirculatory intensive care. Blood and LCR analysis exclude the eventuality of a toxic accident, an anaphylaxia or spinal anesthesia.
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For the last 40 years transtracheal ventilation has been suggested as a means of bypassing the glottis in emergency in patients unable to be intubated or ventilated by mask. A catheter has been designed to be easily inserted into the crico-thyroid membrane. ⋯ Barotrauma is the main danger. However, this method of providing oxygen and/or mechanical ventilation may be extended to the postoperative period, the exit of the insufflated gas mixture being assured at all times.
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Randomized Controlled Trial Clinical Trial
[Factors changing the length of analgesia in spinal anesthesia].
So as to determine the effects of some factors on the duration of bupivacaine spinal anaesthesia, a prospective controlled study was carried out on 152 ASA I or II patients. They were randomly allocated to six groups. The patients of group I were given 4 ml of 0.5% bupivacaine at 27 degrees C. ⋯ The patients of group V were given 4 ml of 0.5% bupivacaine at 20 degrees C and those of group VI were given 4 ml of 0.5% bupivacaine at 5 degrees C. There is significant difference between regression times of sensory analgesia of group II and group I, group IV and group III, group VI and group V. The choice of product to lengthen analgesia in spinal anaesthesia depends on the use of each anaesthesist, the characteristic of patients and the duration of surgery.