Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1987
[The value of prick tests in the detection of anaphylaxis caused by muscle relaxants].
Intradermal tests (IDR) are a sure diagnostic procedure for confirming the IgE origin of anaphylactoid accidents due to muscle relaxant drugs. Because carrying these out and interpreting them correctly is difficult, epidermal prick-tests (PT) could be used if they proved as sure as IDR. To ascertain this, IDR and PT were carried out in 38 patients who had a shock after being given a muscle relaxant 6 months to 5 years previously; for these tests, increasing concentrations of five muscle relaxants were used (suxamethonium, gallamine, alcuronium, pancuronium and vecuronium). ⋯ PT with muscle relaxants were sensitive, specific of anaphylaxis, and permanent. Easy to carry out, easily interpreted, they could be useful as tests for predicting latent sensitisation in risk patients requiring muscle relaxants. But all muscle relaxants must be tested, and not just the one the anaesthetist is likely to use.
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In three consecutive patients suffering from life-threatening asthma in a comatose state (mean age: 37 +/- 4 yr; Glasgow coma score: 3; bilateral mydriasis), intracranial pressure was monitored with an extradural transducer set-up a mean of 2 h after the onset of the coma. The aims were to detect intracranial hypertension and to improve its therapy. Basal therapy associated: 1) mechanical ventilation; 2) theophylline 1.5 g X 24 h-1, salbutamol 30 mg X 24 h-1, hydrocortisone 2 g X 24 h-1, pancuronium 0.5 mg X kg-1 X 24 h-1; 3) pentobarbitone 35 mg X kg-1 X 24 h-1, normal hydration, normothermia and 30 degrees head-up tilt. ⋯ Hypoxaemia, hypercapnia and high peak airway pressures could explain the intracranial hypertension. All patients recovered without sequelae. This data should make us use with great care all treatments likely to increase the intracranial pressure during life-threatening asthma.
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Ann Fr Anesth Reanim · Jan 1987
Randomized Controlled Trial Comparative Study Clinical Trial[Effects of intravenous naloxone on the secondary effects and analgesia after epidural injection of fentanyl].
On demand intravenous naloxone reverses respiratory depression following epidural morphine but does not have any effect on analgesia. This study aimed to assess the action of a preventive naloxone infusion on the side-effects and analgesia induced by epidural fentanyl. Sixteen patients were studied. ⋯ Duration of analgesia was not statistically different in the two groups. This preventive action of intravenous naloxone on the supraspinal adverse effects of epidural fentanyl was not accompanied by a reduction in analgesia. This could lead to widespread use of this analgesic technique.
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Ann Fr Anesth Reanim · Jan 1987
Randomized Controlled Trial Comparative Study Clinical Trial[Comparative trial of propofol and ketamine in anesthesia for the baths of severely burnt patients].
Ketamine was the normal anaesthetic drug for carrying out the baths of severely burnt patients. It was compared with propofol in a study of 50 patients (greater than 50 UBS) randomly assigned to two groups: 2.5 mg . kg-1 propofol and 2 mg . kg-1 ketamine. The speed of induction was the same for both groups, surgery beginning within the same time intervals. ⋯ Respiratory rate increased, because of the lack of analgesia. Recovery was very quick, complete and with no bothersome adverse effects in the propofol group. These hypercatabolic patients could therefore be fed early postoperatively; also, there was no deleterious psychological interference in these deeply disturbed patients.
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Ann Fr Anesth Reanim · Jan 1987
Randomized Controlled Trial Comparative Study Clinical Trial[Use of isoflurane in a closed-circuit. Economic advantages].
The present study was designed to assess whether isoflurane requirement was significantly affected by fresh gas flow in a closed-circuit system. Sixty patients scheduled for orthopaedic procedures were randomly assigned into three groups. In group A (n = 20), anaesthesia was conducted with a fresh gas flow of 482.5 +/- 186.6 ml X min-1, corresponding to the patient's metabolic demand. ⋯ Alveolar concentration of isoflurane was set at 0.92 vol. % according to Lowe and Ernst. Statistical analysis was carried out using Student's test for means. Anaesthesia lasted 138 +/- 88.3 min in group A, 125.5 +/- 45.1 min in group B and 146.5 +/- 50 min in group C, no difference being significant.(ABSTRACT TRUNCATED AT 250 WORDS)