Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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Comparative Study
[Hemodynamic effects of genu-pectoral position during the surgery of lumbar disk herniation: spinal anesthesia versus general anesthesia].
Spinal anesthesia (SA) for lumbar disk surgery in the genu-pectoral position (GP) has been proposed as an alternative to general anesthesia (GA). This study compares the haemodynamic effects of GP in two groups of patients undergoing either SA (n = 43) or GA (n = 40). ⋯ MAP and HR were significantly lower in the GA group after GP. We conclude that SA during GP for lumbar disk surgery is haemodynamically well tolerated.
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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.