Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1993
ReviewMechanisms of activation of human mast cells and basophils by general anesthetic drugs.
A study was performed about the effects of increasing concentrations of muscle relaxants (suxamethonium, d-tubocurarine, vecuronium, and atracurium), hypnotics (propofol, ketamine, and thiopental), opioids (morphine, buprenorphine, and fentanyl), and benzodiazepines (diazepam, flunitrazepam, and midazolam) on the release of preformed (histamine and tryptase) and de novo synthesized (prostaglandin D2: PGD2 and peptide-leukotriene C4: LTC4) chemical mediators from human basophils and mast cells isolated from skin (HSMC), lung parenchyma (HLMC) and heart tissue (HHMC). None of the drugs tested induced the release of histamine or LTC4 from basophils of normal donors. Suxamethonium did not induce mediator release from any type of human mast cell tested. ⋯ Diazepam and flunitrazepam only induced a small release of histamine from mast cells, whereas midazolam caused the release of histamine from HLMC. The biochemical pathways underlying the release of mediators from human mast cells induced by drugs used during general anaesthesia are different from those underlying the immune release of histamine. From the results obtained with the in vitro model described here, it is clear that new drugs promising for the anesthesiologic arena should be tested in vitro before their potential histamine-releasing activity is experienced in vivo.
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Ann Fr Anesth Reanim · Jan 1993
[Monitoring of hemostasis during liver transplantation: contribution of thromboelastography].
Monitoring of coagulation is mandatory during liver transplantation (LT). Standard coagulation tests may be routinely used. However, they give static information and may be inadequate in case of severe coagulation defect. ⋯ Twelve of them had a CLI value reaching 0%, associated with severe generalized oozing. Aprotinin (200,000 to 600,000 KIU) corrected these abnormalities. These results show that TEG may not be very helpful to determine whether platelets or fibrinogen are involved in the phase of hypocoagulability detected after unclamping.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1993
Randomized Controlled Trial Clinical Trial[Axillary plexus block by simultaneous blockade of several nerves. I. Influence of the volume of the anesthetic solution].
The influence of the volume of local anaesthetic solution on axillary blockade was investigated in a prospective randomized double-blind study including 120 patients presenting for upper limb surgery. A peripheral nerve stimulator was used to carry out the axillary block with a multiple injection technique. The musculocutaneous, radial, median and ulnar nerves were routinely stimulated. ⋯ The data demonstrated that, for a same amount of local anaesthetic, the larger volumes provided better quality sensory blockade than the smaller ones (p < 0.03). However, the volume of solution used affected neither the time of onset nor the duration of anaesthesia, nor the degree of motor blockade. It is concluded that, despite the use of a neurostimulator and simultaneous infiltration of several nerve trunks, the volume required to ensure a reliable degree of sensory block with the technique of axillary block is comprised between 40 and 50 ml (25 ml.m-2).
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Ann Fr Anesth Reanim · Jan 1993
Review[Anesthesia for non-specific surgery in a post-transplantation patient].
The increase of non specific surgeries in transplanted patients may be related to the better survival achieved by the efficacy of immunosuppressive therapy and improved surgical and intensive care conditions. Therefore, the anaesthetist may be mandated to give anaesthesia in such patients, treated in hospitals which are not involved in transplantation procedures. The ignorance of the main physiologic and pharmacological changes in the new grafted organ as well as the knowledge of high risks of rejection or infection contribute to the anxiety often encountered in front of these patients. ⋯ Ciclosporine enhances mainly the effects of muscle relaxants. Peroperative invasive monitoring requires full aseptic techniques. Invasive monitoring should be discussed in terms of benefit-risk ratio.(ABSTRACT TRUNCATED AT 400 WORDS)
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Ann Fr Anesth Reanim · Jan 1993
Randomized Controlled Trial Comparative Study Clinical Trial[Perioperative perfusion in children: evaluation of a new perfusion solution].
A new intravenous solution (B66) containing 0.9% dextrose in water for infusion therapy in infants and children was assessed. Forty-one children, aged between 6 months and 11 years, scheduled for elective non haemorrhagic surgery, were randomly assigned to two groups: children in group I (n = 22) were given 1% dextrose in lactated Ringer's solution (RLG1), and those in group II (n = 19) the commercially available solution B66 (0.9% dextrose in lactated Ringer's solution). The fluids were administered throughout the study with volumetric infusion pumps (IVAC 541). ⋯ Total protein levels decreased postoperatively significantly in both groups. Preoperative age-related differences in total protein concentrations were also observed postoperatively. Sodium concentrations remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)