Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1993
Review[Continuous monitoring of mixed venous blood oxygen saturation].
Mixed venous oxygen saturation (SvO2), measured on pulmonary artery blood, is a convenient indicator of matching between O2 transport (TaO2) and O2 body consumption (VO2). The measurement technique is based on the haemoglobin reflection spectrophotometry principle using two or three wave lengths. The Fick principle points out that SvO2 depends on five parameters: SvO2 = SaO2 - (VO2/CI x Hb x PO) where SaO2, CI and PO respectively represent arterial O2 saturation, cardiac index and O2 affinity. ⋯ Finally, the existence of a right-to-left shunt will modify the SvO2 values through various mechanisms. However the SvO2 measured, in the pulmonary artery, remains reliable, whereas the presence of a left-to-right shunt will highly alter SvO2 basal value, only its time course remaining significant. SvO2 monitoring, element of diagnosis and monitoring, as well as a warning signal, has a priori specific indications poorly assessed, so far. (ABSTRACT TRUNCATED AT 400 WORDS)
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Ann Fr Anesth Reanim · Jan 1993
Multicenter Study[Information to relatives of organ donors. Factors of consent or refusal. Results of a multicenter study].
The French law on organ harvesting in brain dead patients allows this to be done without the family's consent, but prescribes to inform the relatives. Despite this, most teams do not harvest organs if the family is strongly opposed to the procedure. Information given to the relatives is therefore a very important point in the management of the donor. ⋯ This ratio, which did not depend on the hospital, increased with the age of the donor: 66% for donors aged less than 18 years to 86% for those more than 50 years old. The aetiology of brain death was not a factor determining acceptance of the donation. The main factor was the conditions of interview: acceptance rate was the highest when there was a one hour delay between giving the information on the donor's brain death and that concerning organ donation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1993
The incidence and clinical features of anaphylactic reactions during anesthesia in Australia.
The details of 826 patients referred to an Anaesthetic Allergy Clinic over a 17-year period are described. 443 were classified as having severe immediate anaphylactic reactions and in the majority of these (263) a muscle relaxant was involved. In Australia, the most common cause of a reaction is alcuronium, which probably reflects usage, although it is the most commonly found to give a positive skin test in relaxant reactors. Suxamethonium and atracurium appear to have an incidence of reactions greater than predicted by market share and pancuronium and vecuronium appear safer both on incidence of reactions and on positive skin tests in reactors. ⋯ Cardiovascular collapse is the most common presenting problem and is the only problem in 10%. Skin changes are the next most common and then bronchospasm which may be transient and is the hardest feature to treat. With an investigation protocol based on history, skin and RIA testing subsequent anaesthesia is usually safe.
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Total intravenous anaesthesia (TIVA) is becoming increasingly popular among anaesthetists. It has several advantages, namely each component of the anaesthetic protocol can be independently controlled, and the operating room remains unpolluted with nitrous oxide or volatile anaesthetic agents. TIVA aims to maintain a constant blood concentration of each anaesthetic agent. ⋯ Closed loop systems are still research tools. It is concluded that computer-driven anaesthesia is the equivalent to the vaporizer for volatile agents. However, further clinical studies are needed to determine whether the advantages of this technique outweigh its disadvantages.