Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1992
Randomized Controlled Trial Comparative Study Clinical Trial[Propofol versus etomidate in short-time urologic surgery].
Thirty patients, scheduled for short urological surgical procedures and ranked ASA 1 or 2, were randomly assigned to two homogenous groups. In group P, they were given a 2 mg.kg-1 bolus of propofol and 10 micrograms.kg-1 of alfentanil, followed by a continuous infusion of propofol (5 mg.kg-1.h-1) and 5 micrograms.kg-1 doses of alfentanil. In group E, they were given a 0.3 mg.kg-1 bolus of etomidate, followed by an infusion (1.5 mg.kg-1.h-1). ⋯ On the other hand, in group E, there was little or no haemodynamic alteration, but there often was a trismus at induction. Hypoxia also occurred during induction with etomidate, being severe enough in one case to require tracheal intubation and artificial ventilation. The reasons for this hypoxia seemed to be the apnoea and the trismus, which tends to hinder assisted ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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The anatomy of the posterior lumbar epidural space (PLES) has been extensively studied. Besides the anatomists, surgeons, radiologists and anaesthetists have taken an interest in this. However, because each one has considered the PLES from his own specialist field, descriptions are not always concordant. ⋯ The fatty tissue could therefore be compressed and take any of the shapes which have been described on epidurography. On the other hand, should it be torn, it seems this fatty tissue could make up these haphazard fibrous tracts tensed between the dura and the vertebral arch, such as described in classical anatomy, as Bonica recalled. These can be clearly seen during surgical and anatomical dissections, and during endoscopies carried out on cadavers with sufficient optical means, as opposed to the medial fibrous band fixing the dura to the vertebral arch.(ABSTRACT TRUNCATED AT 400 WORDS)
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Ann Fr Anesth Reanim · Jan 1992
Review[Consequences and prevention methods of hemodynamic changes during laryngoscopy and intratracheal intubation].
In patients ranked ASA 1, laryngoscopy and intubation lead to an average increase in blood pressure of 40 to 50%, and a 20% increase in heart rate. These changes, which are greatest one minute after intubation, last for 5 to 10 min. They are due to sympathetic and adrenal stimulation, which may also result in some arrhythmias. ⋯ In clinical practice, prevention will first rely on a sufficient dose of narcotics. In some cases, nitroglycerin or beta blockers may be used so as to decrease the doses of narcotics, without altering their efficacy; however, the risk of hypotension should be constantly borne in mind. If preventing measures have not been taken, short-acting antihypertensive agents (beta blockers, calcium blockers) should be used in patients who develop major hypertension during laryngoscopy and intubation.
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Ann Fr Anesth Reanim · Jan 1992
Review Case Reports[Tracheal intubation in patients with cervical spine injuries using a fiber optic laryngoscope].
Eleven patients, with a cervical spine injury and scheduled for elective cervical spine fusion at least 48 h after their initial trauma, were intubated using a new fiberoptic laryngoscope (Bullard). This technique uses either a semi-rigid guide independent of the laryngoscope blade, or a rigid one attached to the blade. The cervical spine was immobilized with either a collar or a halo. ⋯ This is confirmed by the time required, 44 +/- 22 sec for the rigid guide, and 97 +/- 92 sec for the semi-rigid one. In the patient in whom this technique failed at the first attempt, endotracheal intubation was carried out by the nasal route and controlled by the fiberoptic laryngoscope. This technique enables a rapid and easy orotracheal intubation in trauma patients with an immobilized cervical spine, but careful training is necessary.
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Ann Fr Anesth Reanim · Jan 1992
Randomized Controlled Trial Comparative Study Clinical Trial[Effect of hygrophobic filter or heated humidifier on peroperative hypothermia].
A study was carried out to find out whether the use of a hygrophobic filter (Pall, Ultipor) or of a heated humidifier (Dräger, Aquapor) during surgery had any effect on a patient's intraoperative core temperature and thermal balance. Seventy-five ASA I or II patients scheduled for gynaecological surgery were randomly assigned to three groups: group A (n = 25), where no warming device was used; and two groups (n = 25 for each) where inhaled gases were humidified and heated with either a hygrophobic filter set up between the endotracheal tube and the Y-piece (group B) or a heated humidifier set to 100% saturation at a temperature of 41.5 degrees C (group C). The patients were all anaesthetised with the same technique (thiopentone 5 mg.kg-1, dextromoramide 0.03 mg.kg-1 and 0.1 mg.kg-1 of either pancuronium or vecuronium, followed by enflurane with nitrous oxide in oxygen); the perfused fluids were not heated. ⋯ In the recovery room, patients were warmed up with an electric blanket. Shivering was ranked from "0" to "+ +". There were no differences between groups as far as age, drug doses, perfusion volumes and room temperature were concerned.(ABSTRACT TRUNCATED AT 250 WORDS)