Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1990
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of enoximone versus tobutamine in the treatment of low cardiac output after cardiac surgery].
Enoximone, a new cardiotonic agent not related to glycosides or catecholamines, has been suggested for treatment of low cardiac output syndromes occurring after cardiopulmonary bypass (CPB). The aim of the present study was to compare enoximone with dobutamine in the management of such cases. Twenty consecutive patients who had undergone cardiac surgery with CPB and who had a cardiac index (CI) less than 2.5 l.min-1.m-2, pulmonary capillary wedge pressure greater than 12 mmHg, and no renal failure, were randomly assigned to receive either enoximone (group E, n = 10) or dobutamine (group D, n = 10). ⋯ No other inotropic drug was used during the study period. The aim was to obtain an increase in CI greater than or equal to 30% at the end of the first hour of treatment. Excessive systemic hypotension with low SVR was treated with volume loading.(ABSTRACT TRUNCATED AT 250 WORDS)
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The rate of urine formation and its composition are influenced by the different drugs used during surgery. Anaesthetics act on renal function, not only directly, but also by producing changes in cardiovascular function and in neuroendocrine activity. Many factors may be incriminated: lowered blood pressure and cardiac output, increased sympathetic outflow (renal nerve stimulation and increased plasma catecholamines), increased release of renin, angiotensin and vasopressin. ⋯ Acute renal failure (ARF) is a frequently lethal complication of critical surgical illness, due to a variety of factors which interfere with glomerular filtration and tubular reabsorption, such as renal hypoperfusion or nephrotoxic insults. In fact, the initiating aggression ultimately culminates in the development of one or more of the maintenance factors (decreased tubular function, tubular obstruction, decreased GFR and RBF) that reduce urine flow and osmolar excretion. Good management during the perioperative period tends to minimize the risk of developing ARF.
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Pain relief is one of medicine's most important challenges and the first aim of anaesthesia. The most common technique of postoperative analgesia remains intramuscular or subcutaneous opiates. There has been a better understanding of the mechanisms of action of opiates over the last decade, and new techniques and methods of administration have been developed especially their regional application. ⋯ Opiates and local anaesthetics given by the spinal route are compared. The clinical applications of intrathecal and epidural opiates are discussed, especially in the fields of postoperative analgesia, treatment of chest trauma, and cancer pain. Lastly, the few controlled studies concerning the use of opiates in peripheral nerve blocks, especially brachial plexus blocks, and the prospects of this new technique of giving opiates regionally are discussed.
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Rapid fluid infusion remains the cornerstone for therapy of hypovolaemic shock. The principal limitations of flow rate are governed by the four variables of Poiseuille's law: tube internal diameter and length, viscosity of the fluid passing through the tube, and the pressure gradient between the two ends of the tube. ⋯ Dry-heat warming devices and microfiltration, to remove microaggregates and prevent non haemolytic febrile transfusion reactions, seem necessary when carrying out rapid transfusions. However, the use of microaggregate filters could be avoided by the routine production of leukocyte-poor red blood cell concentrates.
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Ann Fr Anesth Reanim · Jan 1990
Review Case Reports[Venous catheterization and congenital abnormalities of the superior vena cava].
Persistent left superior vena cava is encountered in about 0.3 to 0.4% of human beings. It derives from remnants of the left cardinal vein system. This results in either a duplication of the superior vena cava or in a single left vena cava. ⋯ Diagnosis was easily provided by angiography. Clinical course was uneventful. Despite its usual good tolerance, the persistence of a left vena cava, as an isolated anomaly, must not be neglected as it carries many practical implications which are reviewed.