Anesthésie, analgésie, réanimation
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Anesth Analg (Paris) · Jan 1981
[Intervention among patients with right bundle branch block and left anterior hemiblock. Operatory risk (author's transl)].
In order to assess the risk of advanced heart block during anesthesia in patients with right bundle branch block and left anterior hemiblock, 35 consecutive patients were monitored throughout the pre-, intra- and postoperative period. As conventional ECG monitoring may only detect advanced atrioventricular block, patients were monitored according to the Holter method which can easily detect even minor changes of atrioventricular conduction namely slight increased PR interval or dropped P wave. All patients were asymptomatic, in normal sinus rhythm without second degree AV block. ⋯ They immediately regressed at the termination of the sinus bradycardia either spontaneously or following atropine injection, strongly suggesting the responsability of increased vagal tone. Thus general or epidural anesthesia did not compromise infranodal conduction in any of the observed patients. These data indicate that anesthesia can be safely used without prophylactic preoperative insertion of pacemakers in patients with asymptomatic chronic right bundle branch block and left anterior hemi-block.
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Anesth Analg (Paris) · Jan 1981
[Indications of analgesia with absolute alcohol or phenol for intractable pain in thoracic and abdominal cancerous pathology (author's transl)].
This work analyzes the results of 88 blocks for intractable pain in thoracic and abdominal malignant diseases. Results and duration of analgesia are compared in regard to the localization of pain and to the use of alcohol or phenol. Best analgesic results are obtained in the pelvic pains and especially in the colorectal pains. ⋯ Analgesic results are the same with alcohol or phenol, but duration of analgesia seems to be longer with phenol. The two routes of administration, subarachnoid or epidural, seem to give equal results. Motor paralysis of the bladder or the rectum may occur, especially in the low pelvic localizations and these complications justify careful selection of the indication.
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Epidural opiate application was performed in 75 patients with chronic pain due to abdominal cancer. To reduce the risk of local infection, the epidural catheter was in part placed subcutaneously. Degree and duration of analgesia were determined after epidural morphine (with and without bupivacaine), pethidine or fentanyl. ⋯ A combination of epidural morphine with small doses of local anesthetics caused prolonged action and delayed the onset of tolerance. Besides slight influences on respiratory function, which may be referred to the initial period of systemic absorption, there were no relevant side-effects. Regarding certain precautions the epidural application of morphine may have advantages in comparison to systemic analgetics in treatment of chronic pain.
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Anesth Analg (Paris) · Jan 1981
[Curing trial of complicated oncologic pain by D-phenylalanine (author's transl)].
Aim of investigations: Very often, chronic pain treatments used for the management of terminal ill cancer patients do not prevent acute or incident pain from coming up. For twenty months D-phenylalanine (DPA), an enkephalinase inhibitor, has been investigated in order to forestall this pain. ⋯ DPA seems a useful drug to prevent acute or incident pain in malignant diseases. Our data point out the consequences the enkephalinases inhibitors will take up for the cure of intractable cancer pain.
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Anesth Analg (Paris) · Jan 1981
[Hundred cases of general anesthesia for laryngoscopy and/or bronchoscopy, in children under five years age (author's transl)].
The authors describe an anesthetic technique used for endoscopies (laryngo-tracheo-bronchoscopies) in 100 children under five years age. Three different apparatus for jet ventilation are used: manual injection, automatic injection and high frequency positive pressure ventilation. ⋯ With the second one (Wolf injectomat), injection of O2 or O2/N2O is automatic. The aga bronchovent is used for high frequency positive ventilation with O2.