Annales françaises d'anesthèsie et de rèanimation
-
Ann Fr Anesth Reanim · Jan 1996
Review[Prevention of respiratory complications after abdominal surgery].
Abdominal surgery, especially upper abdominal surgical procedures are known to adversely affect pulmonary function. Pulmonary complications are the most frequent cause of postoperative morbidity and mortality. This review article aimed to analyse the incidence and risk factors for postoperative pulmonary morbidity and their prevention. ⋯ The various techniques of physiotherapy (chest physiotherapy, incentive spirometry, continuous positive airway pressure breathing) seem to be equivalent in efficacy; but intermittent positive pressure breathing has no advantages, compared with the other treatments and could even be deleterious. Chest physiotherapy and incentive spirometry are the most practical methods available for decreasing secretion contents of airways, whereas continuous positive airway pressure breathing is efficient on atelectasis. In stage II or III COPD patients, admission in a intensive therapy unit and prolonged mechanical ventilation may be required.
-
Pneumatic tourniquets, often used to provide a bloodless operating field, carry a risk of adverse effects. Limb exsanguination by gravitation is less aggressive than by mechanical means. Skin, muscles, nerves and vessels suffer maximally under tourniquet because of mechanical pressure, with both a sagittal force, responsible for compression and an axial force responsible for stretchening. ⋯ In order to minimize its side effects, the tourniquet must be used within the frame of a strict procedure, with a well adapted and regularly checked equipment. Duration of ischaemia should be as short as possible and not continue for more than two hours, with a reperfusion of 15 minutes every hour. Local hypothermia seems to be a safe means for decreasing side effects.
-
Ann Fr Anesth Reanim · Jan 1996
Multicenter Study[Anesthesia and intensive care of subarachnoid hemorrhage. A survey on practice in 32 centres].
To assess the current practices in anaesthesia and intensive care in patients experiencing subarachnoid haemorrhage (SAH). ⋯ Twenty-nine French and three non French centers answered the questionnaire. In 14 centers, more than 60 SAH had been treated in the previous year. Angiography was performed under sedation with a benzodiazepine associated with an opioid (54%). Criteria for choosing an endovascular approach were the site of the aneurysm (81%), its neck size (42%) and the underlying disease (42%). Anaesthesia was induced with either propofol (60%) or thiopentone (40%) associated with an opioid and a muscle relaxant. It was maintained with either isoflurane (59%) or propofol (41%). Nitrous oxide was often associated (62%). During anaesthesia, nimodipine (84%), mannitol (69%), anticonvulsants (47%), dopamine (31%) and lidocaine (9%) were also administered. Postoperatively, nimodipine was administered for prophylaxis of vasospasm (97%) and transcranial Doppler was employed to diagnose vasospasm (50%). Other techniques of care included hypervolaemia (89%), controlled arterial hypertension (36%) and haemodilution (36%).
-
Human albumin is available either as a 4 or a 20% solution. Only the latter is a plasma expander which increases volaemia by an amount corresponding to the four-fold of the infused volume. ⋯ Therefore, when the administration of albumin is indicated, the 20% solution should be preferred, as well as for volume expansion as for other uses, due to a decreased sodium load. However, this recommendation has not been substantiated by comparative studies.
-
Ann Fr Anesth Reanim · Jan 1996
Clinical Trial[A study of pneumatic performances of 2 new anesthesia ventilators: a trial].
To assess the pneumatic performance of two new anaesthesia ventilators. ⋯ These two new machines with pneumatic compensation overcome the main drawback seen with conventional "bellows-in-box" ventilators.