Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1994
[Value of transcranial Doppler ultrasonography in the management of severe head injuries].
Transcranial doppler ultrasonography (TCD) is a non invasive technique for the assessment of cerebral blood flow (CBF). The aim of this prospective study was to evaluate the benefit of TCD for the monitoring of major head trauma patients. Therefore 10 of such patients, aged 17 to 37 years, had a TCD at admission and subsequently at least twice a day. ⋯ In the opposite there was no statistically significant relation between ICP and MV (r = 0.18) nor between CPP and MV (r = 0.23). However, a MV over 100 cm.s-1 was regularly associated with a ICP over 60 mmHg. The close correlation between RI, PI and ICP allows to use RI or PI to estimate ICP.(ABSTRACT TRUNCATED AT 250 WORDS)
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Propofol ensures a calm and rapid induction of anaesthesia in case of planned cardioversion for supraventricular arrhythmia. An appropriate level of anaesthesia is obtained with a dose of 1.4 to 2 mg.kg-1. Propofol does not affect the success rate of cardioversion. ⋯ The frequent association with cardiac disease, in particular valvular disease or coronary insufficiency, should be taken into account and may represent a contra-indication for the administration of propofol. Furthermore, administration of this agent is not indicated if the arrhythmia is poorly tolerated, because of the risk of increasing hypotension. The known advantages of propofol on recovery have no significant role in this indication.
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Ann Fr Anesth Reanim · Jan 1994
Comparative Study Clinical Trial Controlled Clinical Trial[Risk of secondary neuromuscular blockade after autotransfusion of blood drawn from the patient following curare administration].
A secondary neuromuscular blockade can occur after transfusion of autologous blood withdrawn after injection of muscle relaxants. In this study time course of muscle relaxation after transfusion of blood withdrawn before or after administration of atracurium (A) or vecuronium (V) was assessed. Forty adults undergoing haemorrhagic urologic surgery were included in the study. ⋯ The intensity of blockade was more important after vecuronium than after atracurium (p < 0.01 from T2 to T11 between groups A2 and V2). In group A2, the T4R had not reached the control level at the end of the procedure (0.78 at T11 vs 0.80 at T0). These data emphasize the importance of withdrawing blood units before administration of muscle relaxants.(ABSTRACT TRUNCATED AT 250 WORDS)
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Ann Fr Anesth Reanim · Jan 1994
Meta Analysis[Selective digestive decontamination in patients under reanimation].
Nosocomial infections increase morbidity and mortality in hospitalized patients. ICU patients are at high risk of sustaining them, due to the high rate of invasive procedures and their poor health state. Conventional methods for decreasing the incidence of infection in ICU patients include handwashing, catheter care, strict antibiotic policy, and reduction of environmental sources of infection. ⋯ This benefit is most obvious in trauma patients, severely burned patients and after orthopic liver transplantation. Several studies reported a significant decrease in the overall rate of infections, especially extrapulmonary infections, including blood, urinary tract, wounds, abdominal, and catheter related infections. Despite a major decrease in infection rates with SDD, most studies did not show lowered mortality rates.(ABSTRACT TRUNCATED AT 400 WORDS)