Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1985
Clinical Trial Controlled Clinical Trial[Enflurane and extracorporeal circulation. Peripheral vascular effects and consequences of hypothermia on its biotransformation].
The effects of enflurane on systemic vascular resistance and venous capacitance, and its biotransformation during hypothermia, were studied in patients undergoing cardiovascular surgery with enflurane anaesthesia. When administered during cardiopulmonary bypass (CPB), cardiac regulatory mechanisms being therefore excluded, enflurane induced an arteriolar vasodilation related to the concentration inhaled. An inspired concentration of 2.5% in hypothermia (28 degrees C) produced a drop in systemic vascular resistance of 30% from control level. ⋯ The rise in the blood gas solubility coefficient during hypothermia was only partly balanced by haemodilution. Therefore, inspired enflurane concentration should be higher during hypothermic CPB than during normothermic anaesthesia to obtain the same effects. For the same amount of enflurane inhaled, the fraction of enflurane metabolized was higher in hypothermia than in normothermia, but the inorganic fluoride plasma concentration at its highest never reached the level of 50 mumol X 1(-1) regarded as the nephrotoxic threshold.
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Ann Fr Anesth Reanim · Jan 1985
[Changes in temperature during transurethral resection of the prostate under peridural anesthesia].
Superficial and central body temperatures were measured during anaesthesia and recovery in eleven elderly patients undergoing transurethral resection under epidural anaesthesia. A significant decrease in central body temperature as measured on the tympanic membrane was found during surgery. After a significant increase during induction of anaesthesia, mean skin temperature remained stable throughout surgery. ⋯ During recovery, all temperatures increased significantly. But mean body temperature returned to normal faster than central body temperature. Routine monitoring of core temperature and the use of warmed irrigation fluids are recommended during transurethral resections in elderly patients.
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Ann Fr Anesth Reanim · Jan 1985
Randomized Controlled Trial Clinical TrialSkin testing in the investigation of reactions to intravenous anaesthetic drugs. A prospective trial of atracurium and tubocurarine.
Intradermal skin testing is widely used to determine the causative drugs of presumed anaphylactic anaesthetic reactions. This paper sets out to evaluate the usefulness of skin tests, both intradermal and prick testing, in the prediction of anaesthetic reactions. The muscle relaxant drugs tubocurarine and atracurium were chosen for study since they are known to produce a high incidence of minor histaminoid reactions. ⋯ The results of the trial, combined with external reports to this centre, indicate that intradermal testing of anaesthetic drugs, particularly muscle relaxants, produces a high incidence of false positive results. This probably reflects their pharmacological activity rather than antigenicity. It is recommended, therefore, that skin testing should be reserved for situations in which there are strong indications from laboratory tests, backed by case history, of immune sensitization.
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Intradermal testing is a valid manoeuvre for the determination of the drug responsible for an anaphylactoid reaction during anaesthesia. It does not fill criteria for a screening test and will have limited use in the preoperative diagnosis of anaesthetic allergy unless a high risk group is selected.