Annales françaises d'anesthèsie et de rèanimation
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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.
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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.
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Spinal anaesthetics can induce histopathologic lesions and regional haemodynamic alterations in the spinal cord. There are numerous causes of neurologic lesions, including direct trauma of the spinal cord and nerve roots during puncture or catheter insertion, compromised spinal cord perfusion and direct neurotoxic effect. Histopathologic lesions are localized either in meninges (meningitis or arachnoiditis) or in neuraxis (myelitis or axonal degeneration). ⋯ Incomplete blockade should not necessarily lead to a reinjection. Large volume of hyperbaric lidocaine or repeated injections of such solutions must be avoided as well as preservative-containing solutions. The administration of new compounds by the spinal route must be supported by data of spinal neuropharmacology and the lack of neurotoxicity must have been previously checked with animal studies.
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Ann Fr Anesth Reanim · Jan 1996
Review[Indications and role of albumin for vascular loading during postoperative intensive care].
Prospective clinical trials comparing human albumin to other plasma volume expanders during the three first postoperative days in adult patients were analysed. Fifteen studies were selected. Nine of them concerned the evaluation during the immediate postoperative period, after cardiac surgery with cardiopulmonary bypass (CPB). ⋯ After cardiac surgery, mainly uncomplicated coronary artery bypass graft or valve replacement, albumin can be substituted by HES. These conclusions are only valid for blood losses below 50% of blood volume. The place of isooncotic albumin for fluid resuscitation in case of blood loss exceeding 50% of blood volume cannot be specified.
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Ann Fr Anesth Reanim · Jan 1996
Review[Indications and role of albumin for vascular loading in trauma patients and during preoperative period].
The use of albumin solutions for volume replacement remains controversial. The last American guidelines recommend the use of albumin for resuscitation in case of a contra-indication of artificial colloids or the requirement of sodium restriction. Recent trials did not show any beneficial effect of albumin on the mortality and morbidity rates. ⋯ For resuscitation, albumin could be used when the recommended upper limit of hydroxyethyl starch vol-ume has been reached and fresh frozen plasma not yet required. During preoperative haemodilution, low molecular weight hydroxyethyl starch has at least the same efficacy as albumin. When a rheological effect is required, albumin could be used.