Annales françaises d'anesthèsie et de rèanimation
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In a semi-closed circle system, the inspiratory and expiratory limbs are completely separated and part of the patient's expired air recirculates. CO2 rebreathing is prevented by CO2- absorption with soda lime, which is always incorporated in such a circle. The inspiratory and expiratory valves ensure that gas flow is unidirectional and also prevent rebreathing, even at tidal volumes of 10 ml and ventilation frequencies of 60 c . min-1. ⋯ The values of expiratory resistance are within the recommended limits of the ISO; prewarming and humidification of the inspiratory gas mixture are sufficient without additional equipment. Standard monitoring of the circuit such as measurement of inspiratory O2 concentration and ventilation pressure, including a disconnection alarm, can be used for all age groups; spirometry or end-tidal CO2 measurements ensure normoventilation. The fresh gas flow required in a semi-closed circle system is about 2-4 1 . min-1, so that costs and environmental contamination with anaesthetic gases are relatively low in comparison with a semi-open system.
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Ann Fr Anesth Reanim · Jan 1985
[Anaphylaxis to muscle relaxants. Predictive value of intradermal tests and study of crossed anaphylaxis].
37 patients were studied, all of whom presented with anaphylaxis to a muscle relaxant. The diagnosis was made after simultaneous intradermal testing (IDT), human basophil degranulation tests (HBDT) and Prausnitz-Küstner tests (PK) of passive cutaneous anaphylaxis. Three tests were positive in 6 patients, both IDT and PK in 9, and both IDT and HBDT in 8. ⋯ Pancuronium and vecuronium appeared to be the least likely drugs to cause crossed anaphylaxis. The predictive use of these tests is discussed. It is also suggested that muscle relaxants with only one quaternary ammonium group should be used, this chemical characteristic probably reducing the risks of sensitization.
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The histamine releasing potential of atracurium was assessed by testing skin reactivity in ten patients who had previously suffered from a preanaesthetic anaphylactoid accident, but in whom the diagnosis of anaphylaxis had not been confirmed. Atracurium was injected intradermally in increasing concentrations so as to determine the reactivity level, comparing it in the same patient with that due to d-tubocurarine and alcuronium given in the same way. Skin tests with histamine and 48/80 were also carried out at the same time. ⋯ All the commercial muscle relaxants together with atracurium were tested, even though none of the patients had ever received this last. Anaphylaxis was confirmed when the intradermal reaction was positive with a dilution of 1 in 1,000 and beyond. These tests showed that five patients out of the six had a crossed anaphylaxis, and one of these five was sensitive to all four muscle relaxants (atracurium included).(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1985
[Continuous peridural anesthesia in children less than 2 years old].
Continuous epidural anaesthesia was carried out in 23 children (age 13.9 +/- 6 months, weight 9.09 +/- 2.5 kg) scheduled for long surgical procedure (soft tissue release for club-foot, "pull-through" for Hirschsprung disease, various genito-urinary procedures). The lumbar epidural space was punctured under general anaesthesia with a 19 G Tuohy needle. A graduated 24 G polyurethane catheter was then inserted and fixed. ⋯ The catheter remained in situ 26.7 +/- 4.1 h. No complication was observed. Thus, during surgery, the need for systemic analgesia was avoided and a rapid and safe postoperative recovery was obtained.(ABSTRACT TRUNCATED AT 250 WORDS)