Annales françaises d'anesthèsie et de rèanimation
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Physiologic and pathologic changes due to ageing should be taken in account for the preoperative evaluation and peroperative management of geriatric patients. Pharmacokinetic changes ed to reduce the doses of intravenous agents by 50%. ⋯ Pharmacodynamic deleterious effects are limitative in the choice of some drugs. Cardiocirculatory and pulmonary functions need specific, if possible non invasive monitoring, during surgery, recovery and the early postoperative days.
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Two cases of spinal subarachnoid haematoma occurring after spinal anaesthesia are reported. In the first case, lumbar puncture was attempted three times in a 81-year-old man; spinal anaesthesia trial was than abandoned, and the patient given a general anaesthetic. He was given prophylactic calcium heparinate soon after surgery. ⋯ The patient died on the following day. Both these cases are similar to those previously reported and point out the role played by anticoagulants. Because early diagnosis of spinal cord compression is difficult, the prognosis is poor, especially in case of paraplegia.
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Numerous anaesthetic techniques exist for a patient who presents with a difficult endotracheal intubation. They all require an anaesthetic protocol which cannot be improvised. ⋯ When a fiberoptic bronchoscope is not available, several alternatives can be suggested: local anaesthesia of the glottis, retro-molar and retrograde intubation, or the use of a guide threaded over a lighted stylet; these techniques can be used in an anaesthetized patient breathing spontaneously. In the paralyzed patient impossible to intubate, various trans-laryngeal techniques of ventilation can be used in emergency: jet ventilation via the trans-crico-thyroid route, the use of a cricotomy cannula, or a minitracheotomy set.
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Ann Fr Anesth Reanim · Jan 1990
Comparative Study[Pharmacokinetics of drugs used during the period of cardiac support].
Deep endobronchial instillation of epinephrine (2-5 mg in 5 ml saline, catheter of 50 cm in length), during cardiopulmonary resuscitation in man, results rapidly in efficient blood concentrations, similar to those obtained with i.v. route, but with the additional benefit of a more prolonged effect, due to a slower blood concentration decrease. Despite the large interindividual variations in resulting blood concentrations, also observed with the i.v. route, the endobronchial instillation of lidocaine (5-7 mg.kg-1 in 10 ml saline) results in most cases in blood concentrations located in the therapeutic range. ⋯ This can be of benefit for the prevention of recurrent ventricular fibrillation. This study provides further arguments for a more extensive use of the endobronchial route, especially in out-of-hospital resuscitation.
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Ann Fr Anesth Reanim · Jan 1990
[Intrathecal and epidural administration of alpha adrenergic receptor agonists].
Alpha-agonists are frequently added to local anaesthetic agents to prolong the duration of spinal or extradural anaesthesia. Adrenaline and phenylephrine have been employed most commonly for this purpose. Recent controlled studies indicated that the alpha-adrenoceptor agonist clonidine, when administered spinally, has a dose-dependent antinociceptive effect. ⋯ However, spinally administered alpha-agonists have side effects, which include vasoconstriction in the spinal cord, hypotension, bradycardia or tachycardia, somnolence and respiratory depression. To minimize such complications, great care may be needed, which is described in this review, assessing the minimal required amount of alpha-agonists and effective clinical monitoring. The development of this technique in the management of subarachnoid and extradural anaesthesia and of chronic pain is discussed.