Annales de l'anesthésiologie française
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Positive pressure at the end of expiration (PEEP) applied in spontaneous ventilation (CPAP) has the same ventilatory effects as in controlled ventilation without the harmful actions. Few studies have described the use of CPAP in severe isolated postoperative respiratory insufficiency. CPAP was applied in 16 patients free of chronic bronchopulmonary disease, aged between 22 and 82 years, and suffering after major thoracic and/or abdominal surgery from isolated acute respiratory insufficiency as defined by clinical, blood gas and rediological criteria. ⋯ Alveolar ventilation was assessed by capnography. Improvement was marked in six days : the PaO2/FIO2 ratio at nil PEEP fell from 129 +/- 3.2 to 3.73 +/- 6.5 (mean +/- SD), the score of interstitial and alveolar opacities from 25 to 4 and the atelectasis score from 10 to 1. These results show the efficacy of CPAP in the early treatment of isolated postoperative acute respiratory insufficiency.
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Randomized Controlled Trial Clinical Trial
[Double blind randomized trial of metopimazine: for postoperative nausea and vomiting after cholecystectomy].
Eighty-four patients submitted to cholecystectomy were randomly assigned in a double-blind study either to an intravenous dose of 10 mg of metopimazine, three times D-1, for two days or to an identically administered placebo. A definite superiority of metopimazine as an anti-emetic drug was demonstrated. General acceptance was excellent, but arterial pressure might be looked over closely when metopimazine was administered intravenously immediately after a general anesthesia.
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Amongst 108 surgical patients receiving massive transfusions, 60 died. Study of the aetiology of the haemorrhage, the circumstances of the transfusion, and the role of massive transfusions in the transmission of infectious diseases, disturbances in haemostasis, immunological, respiratory and metabolic complications led to the determination of certain simple criteria of gravity which may restrict their use:age over 60 years; the number of units used, if it exceeds 30; the existence of cirrhosis, of an acute lesion as the source of bleeding, or of peroperative haemorrhage. By contrast, the transmission of hepatitis, coagulation disturbances, immediate or delayed incompatibility accidents and variations in pH, blood potassium and calcium levels and arterial pO2 had little influence on mortality.