Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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This study included 20 children (average 8.5 years) undergoing surgery of the upper limb under brachial plexus block. A method of blocking the brachial plexus using an infraclavicular approach is described. Eighteen brachial plexus block were performed under general anesthesia. ⋯ Post-operative analgesia was satisfactory in all cases. In 10 cases a nerve stimulator was used. It is not necessary for the realization of a brachial plexus block, but the punction is easier under general anesthesia with this instrument.
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Since Althesin was withdrawn from the market, and since Ledingham's report on the inhibitory effect of etomidate on cortisol secretion, anaesthesia in intracranial surgery has lacked an intravenous agent with a pharmacokinetic-dynamic profile making it a suitable alternative to the classic thiopental-isoflurane sequence. Propofol has been used experimentally in neuroanaesthesia for 4 years, and is now ready to be used on a routine basis in neuroanaesthesia. An induction dose of propofol decreases cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMR02), and intracranial pressure (ICP). ⋯ Recovery can thus be rapid. Propofol is used with the same agents or manoeuvres as those used with the thiopental-isoflurane sequence, i.e. lidocaine, fentanyl, esmolol, mannitol, steroids, hyperventilation and lumbar drainage in order to obtain the most relaxed brain and reduce the mechanical pressure exerted on the brain. Propofol can be used for all intracranial pathologies with may be one exception, when a cerebral aneurysm has to be clipped and vasospasm is present.
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Psychiatric disorders are observable in Intensive Care Unit. They belong to all the psychiatric field. Their genesis depend on various factors that often work together and are interdependent: organic, demographic, psychological, environmental, procedural, hypnic. They can be considered as risk factors influencing the development of responses to stress (theory of stress).
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Comparative Study
[Physical and pharmacokinetic properties of anesthetics and sedatives used in neuroanesthesia and resuscitation].
Pharmacokinetics of anesthetic drugs are widely influenced by their physical properties. Lipo-solubility is the most important characteristic. ⋯ The concept of effective compartment allows a best understanding of relationship between concentration, intensity and duration of action of anesthetic drugs. Constant intravenous infusion route of anesthetic drugs administration requires to be discussed.