Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1989
Case Reports[An unusual failure of the 900 C Siemens Servo ventilator].
Lung overinflation was observed in a patient ventilated by a Siemens Servo Ventilator 900 C. The expiratory valves failure to open was related to a transducer disconnection in the expiratory limb. This transducer controls opening of the expiratory valve and when disconnected expiratory valve remains closed.
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The technique described by Winnie in 1973 is supposed to provide a regional block of the femoral, femoral cutaneous, and obturator nerves by a single injection within the femoral nerve sheath. This study aimed to assess the diffusion spaces for the local anaesthetic solution used in this technique. The anatomical study included the dissection of 2 adult and 1 foetal cadavers. ⋯ The other type was an external diffusion, in front of the iliacus muscle, the liquid never reaching the internal side of the psoas major muscle, and therefore the obturator nerve. The "3 in 1" block would therefore seem to be useful for those surgical acts requiring only a block of the femoral and femoral cutaneous nerves, i.e. those involving the anterior aspect of the thigh and knee, the femoral shaft, and the patella. On the other hand, its usefulness for surgery of the hip (dislocation, fractured neck of femur) is rather uncertain.
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Ann Fr Anesth Reanim · Jan 1989
[Liver transplantation in adults: postoperative management and development during the first months].
Recent improvements in the results of orthotopic liver transplantation (OLT) have made this a well-accepted treatment for patients with severe hepatic failure. Current problems encountered following OLT are discussed. Immediate complications comprise surgical bleeding, primary graft non-function, and graft failure due to hepatic artery occlusion. ⋯ Vital (especially CMV) and other opportunistic infections occur generally after the second week. Retransplantation, carried out in 10 to 25% of patients, may be urgent in case of primary graft failure, or hepatic artery thrombosis associated with graft failure, or hepatic artery thrombosis associated with graft failure. Other indications are early graft rejection with severe hepatic dysfunction, chronic rejection with severe VBDS, and recurrence of the initial disease.
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Halothane was administered to 10 ASA or 11 patients undergoing elective peripheral surgery. The vaporizer was included in the delivery gas line of the semiclosed system. Löwe's square root of time model of uptake was used to calculate the required doses of halothane. ⋯ The latter was well above the theoretical values during the first 9 min of anaesthesia (0.85% at the 4 th min). This concentration then decreased progressively, becoming less than the expected value after 15 min (0.4% at the 30 th min). Löwe's model would therefore seem to lead to a gross overestimation of the amount of anaesthetic vapour to be delivered to a patient at the beginning of anaesthesia, and an underestimation thereafter.