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
[Management of unilateral or asymmetrical lung disease (author's transl)].
To determine the indications of body position, continuous positive airway pressure and independent lung ventilation in unilateral lung disease, we turned 10 patients with overwhelming unilateral lung disease from supine to lateral position. All patients were breathing spontaneously with a mask, then associated with continuous airway pressure (10 cm H2O PEEP) in five cases. During these spontaneous ventilation methods, hemodynamic parameters did not change, but arterial blood oxygen tension increased and intra-pulmonary shunting decreased significantly. ⋯ But only one patient survived. We conclude that spontaneous breathing methods are able to provide successful treatment in most of patients with unilateral lung disease. In other patients, only independent lung ventilation is effective.
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Anesth Analg (Paris) · Jan 1981
[Complications of loco-regional anaesthesia in obstetrical practice (author's transl)].
Complications of loco-regional anaesthesia in obstetrics are usually due to several factors: 1. choice of drugs: this must be judicious, taking into account duration of effect, potency and eventual maternal and foetal toxicity. This rule includes also morphinic drugs; 2. choice of technique: taking into consideration the stage of labour and also the eventual surgical procedure. Paracervical block must be avoided because of the numerous side-effects, chiefly foetal distress. ⋯ Peridural anaesthesia may present some complications, like extensive peridural anaesthesia, hypotension. In eclampsia and gemellarity, loco-regional, anaesthesia must be induced with the utmost caution. Moreover, an unrecognized uterine rupture may happen during labour under medullary anaesthesia if the patient had previously a caesarian section.
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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.