Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1989
Review[Treatment of malignant hyperthermia crisis during anesthesia].
Malignant hyperthermia (MH), triggered by anaesthesia, is a rare and potentially fatal condition. It requires immediate and specific treatment. This review focuses on anticipation and organisation of treatment. ⋯ A rational approach to the treatment of hyperkalaemia, circulatory and renal failure is discussed. After the crisis, dantrolene should be continued for a short time. Finally, the nonspecific signs which can give the earliest diagnosis possible of MH are discussed: an early diagnosis and early treatment with dantrolene are essential in reducing the mortality of malignant hyperthermia.
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Ann Fr Anesth Reanim · Jan 1989
Case Reports[An unusual failure of the 900 C Siemens Servo ventilator].
Lung overinflation was observed in a patient ventilated by a Siemens Servo Ventilator 900 C. The expiratory valves failure to open was related to a transducer disconnection in the expiratory limb. This transducer controls opening of the expiratory valve and when disconnected expiratory valve remains closed.
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Ann Fr Anesth Reanim · Jan 1989
[Predictive value of intradermal tests using muscle-relaxing drugs].
A retrospective postal inquiry was carried out to find out a possible relation between the results of intradermal tests carried out for a previous anaesthetic and the course of a second anaesthetic performed afterwards. This study included 350 patients who have had an intradermal test to vecuronium, alcuronium, suxamethonium, gallamine, pancuronium, thiopentone, fentanyl and droperidol between March 1984 and November 1986. Eighty-nine did not reply (25.4%), 183 (52.3%) did not undergo new general anaesthetic since the skin tests, whilst 78 (22.3%) did. ⋯ No new anaphylactic reaction was observed. Three anaesthetists only were not aware of the results of the intradermal tests at the time of the new anaesthetic. These data tend to demonstrate that a muscle relaxant could be injected in a patient who has had a previous anaphylactic reaction with positive intradermal tests, provided that the drug chosen for the new anaesthetic does not give a positive intradermal reaction.
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Halothane was administered to 10 ASA or 11 patients undergoing elective peripheral surgery. The vaporizer was included in the delivery gas line of the semiclosed system. Löwe's square root of time model of uptake was used to calculate the required doses of halothane. ⋯ The latter was well above the theoretical values during the first 9 min of anaesthesia (0.85% at the 4 th min). This concentration then decreased progressively, becoming less than the expected value after 15 min (0.4% at the 30 th min). Löwe's model would therefore seem to lead to a gross overestimation of the amount of anaesthetic vapour to be delivered to a patient at the beginning of anaesthesia, and an underestimation thereafter.
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Ann Fr Anesth Reanim · Jan 1989
[Lumbar epidural catheterization: estimation of the length of the inserted catheter].
A catheter in the epidural space can be the cause of various iatrogenic complications. In order to avoid leaving too great a length in the lumbar epidural space during epidural anaesthesia, graduated Tuohy needles can be used (Perifix), together with graduated epidural catheters. On the latter, a special marking shows that, when it reaches the needle hub, the catheter tip is at the needle bevel. ⋯ This distance, and therefore catheter length, can then be reduced to about 4 cm by carefully withdrawing the catheter. Some possible improvements of catheters and needles are discussed. Knowing exactly how much catheter is within the epidural space could be of particular importance whenever that space is uncommonly far from the patient's skin: obesity, oedema, use of the paramedian route or a very oblique angle of the needle in the sagittal plane.