Annales de l'anesthésiologie française
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After briefly recalling the action of corticosteroids on the normal and pathological lung, the authors review the different etiologies where they can be used in respiratory pathology.
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Following some preliminary remarks on the role of the surfactant in pulmonary physiology and physiopathology, a physiochemical study of the lungs of 26 infants who died in the neonatal period is reported. Two techniques for measuring the decrease in surface tension are set out. The results in the first case (tensiometric method) allow an explanation of the physiopathological aspect of respiratory distress; in the second case (manometric method) the diagrams obtained are characteristic of different clinical states (normal subjects; subjects born prematurely without any hyaline membrane etc...). Furthermore, the second method gives rise to certain hypotheses as to the physiochemical structure of the substances responsible for the tensio-active properties of the surfactant.
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In this paper are considered the etiology, the clinical findings and the management of anaesthesia for a certain number of ENT emergencies, situations of respiratory distress which may lead rapidly to death, or be the cause of severe complications, e.g. -haemorrhage (epistaxis or tonsilar haemorrhage, haemorrhage from carcinoma..), -dyspnea of the adult, neonatal dyspnea and dyspnea of infants and children, -foreign bodies, burns and perforations of the esophagus.
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A technique of jet ventilation under general anesthesia (Alfaterinse suxamethonium) was used in 67 patients, in 55 cases for multiple endoscopic examinations in a single stage, usually laryngoscopy in suspension followed by oesophagoscopy, and in 12 cases, for an operation on the larynx. Arterial gasometry (PaO2 and PaCO2) proved the efficacy of the method, the major risk remaining, in the opinion of the authors, the possibility of excessive pressure which may be avoided by strict supervision.
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The interest of neuroleptics in neurosurgery should be examined in the light of physiopathological and pharmacological data concerning cerebral circulatory autoregulation and intracranial pressure. The fairly favourable conclusions permit one to consider their wide use justified, especially, by the feeble hypnogenic effects, without any marked disturbance of the E. E. ⋯ They therefore occupy a place of choice, in particular during induction of anesthesia in high risk patients, during operations requiring neurological or continuous E. E. G. investigations, in surgery of intracranial aneurysm and, finally, to obtain sedation and post-operative autonomic control.