Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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Nitrous oxide (N2O) is far from inert in terms of its cerebral effects. It can increase the cerebral blood flow (CBF) and the cerebral metabolic rate for oxygen in animals and in man. ⋯ Because of its greater solubility than Nitrogen it can increase ICP, in case of pneumoencephalus and the size and consequences of gazous embolism. In neurosurgical patients, nitrous oxide should be used cautiously in regards of its neurological effects.
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A number of chronic pain syndromes in the perineal area can be related to pudental nerves suffering. The constancy of symptoms among various patients, and in duration for a particular one, alterations revealed by electrophysiologic studies, pain relief by diagnostic blocks, data from anatomic studies, preliminary results of medical and surgical applied therapies, give consistent arguments for possible organic lesions of pudental nerves.
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Since Althesin was withdrawn from the market, and since Ledingham's report on the inhibitory effect of etomidate on cortisol secretion, anaesthesia in intracranial surgery has lacked an intravenous agent with a pharmacokinetic-dynamic profile making it a suitable alternative to the classic thiopental-isoflurane sequence. Propofol has been used experimentally in neuroanaesthesia for 4 years, and is now ready to be used on a routine basis in neuroanaesthesia. An induction dose of propofol decreases cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMR02), and intracranial pressure (ICP). ⋯ Recovery can thus be rapid. Propofol is used with the same agents or manoeuvres as those used with the thiopental-isoflurane sequence, i.e. lidocaine, fentanyl, esmolol, mannitol, steroids, hyperventilation and lumbar drainage in order to obtain the most relaxed brain and reduce the mechanical pressure exerted on the brain. Propofol can be used for all intracranial pathologies with may be one exception, when a cerebral aneurysm has to be clipped and vasospasm is present.
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The otorhinolaryngologic (O. R. L.) diseases seen in the emergency room are frequent and diverse. ⋯ L. lesions only epistaxias are concerned; O. R. L. hemorrhage need to be studied with their specific causes.
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Knowledge of the influence of anesthetics on cerebral blood flow and metabolism is the key to both safe neuroanesthesia practice and understanding the possible neuroprotection offered by these agents. In this paper the authors summarize recent data from the literature. All volatile anesthetics (except for nitrous oxide) produce a dose dependent decrease in cerebral metabolism. ⋯ Autoregulation is preserved during the administration of propofol. The effects of narcotic agents depend largely on the background anesthetic. Pathological conditions induced physiologic changes, and coadministration of other drugs can greatly alter the effects of anesthetics on the brain.