Annales françaises d'anesthèsie et de rèanimation
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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[Is albumin administration useful in critical care for burnt patients?].
The most typical reaction of the organism after a major burn consists in transcapillary shift from plasma into interstitial space. Capillary hyperpermeability, but also changes in colloid osmotic gradient and decrease in interstitial hydrostatic pressure, explain the fluid shift to burned and, at minor importance, non burned areas during the first post-burn day. The extent of capillary hyperpermeability results in inefficiency of colloid infusions in reducing fluid shift to burned areas. ⋯ However, for most groups, restoration of a functional interstitial space has priority during the 24 first post-burn hours, justifying crystalloid supply without colloids. Furthermore, colloid infusion could be responsible for delayed pulmonary oedema, in the first days following initial fluid replacement. After 24 post-burn hours, in patients experiencing severe albumin depletion, infusion of human albumin is justified, in order to favour oedema resorption.
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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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Sevoflurane, a methylethylether halogenated solely with fluorine, is characterized by a low blood/gas solubility (blood/gas partition coefficient = 0.65). This feature allows in a more rapid uptake and elimination than with more soluble agents. MAC is about 2 vol% in young adults and 2.5 vol% in children of more than 6 months of age. ⋯ In adults, recovery is more rapid than with isoflurane. In children, sevoflurane seems a promising agent owing to its good acceptance for mask induction, as well as its favourable haemodynamic profile. However due to its rapid elimination, analgesic drugs should be administered early enough to decrease the incidence of postoperative pain.
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Ann Fr Anesth Reanim · Jan 1995
Review[Effects of anesthesia on postoperative micturition and urinary retention].
Postoperative micturition difficulties, considered as minor complications, have a high incidence. Acute urinary retention can follow all types of anaesthetics or operations. Surgical trauma to the pelvic nerves or to the bladder, postoperative oedema around the bladder neck, and pain-induced reflex spasm of the external and internal urethral sphincters may play a role in the development of urinary retention. ⋯ They should be encouraged to seat, stand or ambulate as early as possible. The alpha 1 adrenergic receptor blocking agents have been used for treatment of organic or functional urinary retention. It is essential to make sure the bladder empties regularly in the postoperative period, especially in day-case surgery or in patients receiving opioid analgesia or after epidural anaesthesia.