Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1988
Case Reports Comparative Study[Changes in intracranial pressure in severe head injured patients in hemodialysis].
Two cases of acute post-traumatic renal failure in severely head injured patients are reported. An increase in intracranial pressure (ICP) was shown up by continuous monitoring during haemodialysis: it was more important during conventional haemodialysis than during continuous arteriovenous haemofiltration. ⋯ The increase in ICP is explained in the dog as a result of blood-brain differences in urea concentration and osmolality leading to an increase in cerebral spinal fluid volume and cerebral tissue swelling. If dialysis is necessary in these patients, it should be carried out early and progressively, the patient's ICP being monitored continuously.
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The prevention of toxic accidents due to local anesthetics is simple. The doses used must be carefully selected according to the drug chosen, the areas to be anaesthetized, and whether or not the local anaesthetic solution contains adrenaline. Continuous infusions of local anaesthetics should be used with great care. ⋯ Using a test dose of adrenaline to detect accidental vascular puncture is simple, but not foolproof (patients treated with beta-blockers, obstetrical cases). The slow injection of local anaesthetics is the best way of preventing this type of accident. Finally, the technique for intravenous regional anaesthesia must be very strict.
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Ann Fr Anesth Reanim · Jan 1988
[Relation of the fall in PO2 in ventilation of the lower lung in pulmonary surgery and the preoperative distribution of respiratory function].
Hypoxaemia during one-lung ventilation is influenced by the anatomic distribution of lung perfusion and hypoxic vasoconstriction. This study aimed to assess whether preoperative selective bronchospirometry could predict the degree of peroperative hypoxaemia. Twelve patients scheduled for pneumonectomy, lobectomy, wedge resection or decortication were included in the study. ⋯ When both lungs were ventilated, mean PaO2 was 390.5 +/- 92.4 mmHg; during one-lung ventilation, it fell to 210.8 +/- 109.2 mmHg. Routine spirometry could not predict the magnitude of fall in PaO2; however, it was correlated with the bronchospirometric oxygen consumption of each lung (r = 0.83; p less than 0.01). The anatomical distribution of lung perfusion seemed to be the predominant factor influencing the decrease in PaO2 during one-lung ventilation.
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Ann Fr Anesth Reanim · Jan 1988
[Continuous monitoring, in the adult, of arterial oxygen saturation during apnea following intubation].
Twenty ASA I or II patients were studied to assess the safety of oxygenation for 4 min prior to intubing, so as to prevent the hypoxaemia related to tracheal intubation. The arterialized capillary blood saturation (Spo2) was continuously monitored with a pulse oximeter Nellcor 100 equipped with a finger probe. Patients spontaneously breathed oxygen (FIO2 = 1) while anaesthesia was induced with pancuronium bromide, thiopentone and fentanyl. ⋯ After the 5 min apnoea period, no saturation was below 95% (mean +/- SD = 98.89 +/- 1.66); at this time, Sao2 and Spo2 did not significantly differ (p less than 0.001). In one case, apnoea had to be interrupted, because of the occurrence of arrhythmias, unrelated to a blood gas disorder (PaO2 = 225 mmHg; Paco2 = 34 mmHg; SaO2 = 100%; pH = 7.44). This study confirmed the efficacy and safety of oxygenating for 4 min before intubation.(ABSTRACT TRUNCATED AT 250 WORDS)
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A case is reported of rapidly resolving pulmonary oedema following post-extubation laryngospasm in a 23 year-old healthy man who underwent emergency resection of a rectal polyp. The laryngospasm occurred immediately after extubation and resolved after administration of curare. The patient was reintubated and auscultation disclosed bilateral coarse and moist rales. ⋯ In addition, this increased negative intra-alveolar pressure was responsible for significant changes in cardiovascular function: right ventricular blood volume, right ventricular ejection fraction and left ventricular after-load increased, while left ventricular ejection fraction decreased. These changes favoured a rise in left atrial and pulmonary blood volumes, with transudation of fluid from the capillaries into the alveoli. Because of the severe consequences of respiratory failure, any patient who suffers acute upper airway obstruction should be observed in the recovery room for at least 3 h in order not to miss this rarely developing, but fortunately rapidly reversible, syndrome.